Provider Demographics
NPI:1174066484
Name:COMFY DENTURE & HEARING SERVICE CORP
Entity type:Organization
Organization Name:COMFY DENTURE & HEARING SERVICE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MINSEOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DD,LD
Authorized Official - Phone:253-886-0855
Mailing Address - Street 1:16014 24TH ST E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-4908
Mailing Address - Country:US
Mailing Address - Phone:253-886-0855
Mailing Address - Fax:253-941-3896
Practice Address - Street 1:18802 MOUNTAIN VIEW DR E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7110
Practice Address - Country:US
Practice Address - Phone:253-886-0855
Practice Address - Fax:253-941-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60239129237700000X
WADN60300984122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty