Provider Demographics
NPI:1730789082
Name:KIM & CERVANTES-KIM DDS PLLC
Entity type:Organization
Organization Name:KIM & CERVANTES-KIM DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVANTES-KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-812-7957
Mailing Address - Street 1:945 ELLIOTT AVE W STE 212
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3645
Mailing Address - Country:US
Mailing Address - Phone:206-812-7957
Mailing Address - Fax:206-812-9506
Practice Address - Street 1:945 ELLIOTT AVE W STE 212
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3645
Practice Address - Country:US
Practice Address - Phone:206-812-7957
Practice Address - Fax:206-812-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty