Provider Demographics
NPI:1366420002
Name:KIM, JUNG HOON (DDS)
Entity type:Individual
Prefix:DR
First Name:JUNG HOON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19108 33RD AVE W
Mailing Address - Street 2:SUITE C
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4728
Mailing Address - Country:US
Mailing Address - Phone:425-774-9571
Mailing Address - Fax:425-774-5727
Practice Address - Street 1:19108 33RD AVE W
Practice Address - Street 2:SUITE C
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4728
Practice Address - Country:US
Practice Address - Phone:425-774-9571
Practice Address - Fax:425-774-5727
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000079691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5043930Medicaid