Provider Demographics
NPI:1366802662
Name:KIM & CHUNG, DDS, PLLC
Entity type:Organization
Organization Name:KIM & CHUNG, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-533-2655
Mailing Address - Street 1:16006 ASH WAY
Mailing Address - Street 2:STE 103
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-6352
Mailing Address - Country:US
Mailing Address - Phone:425-967-8240
Mailing Address - Fax:425-967-8284
Practice Address - Street 1:16006 ASH WAY
Practice Address - Street 2:STE 103
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-6352
Practice Address - Country:US
Practice Address - Phone:425-967-8240
Practice Address - Fax:425-967-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601002761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2056884Medicaid