Provider Demographics
NPI:1831542984
Name:SHIOON KIM DMD PS
Entity type:Organization
Organization Name:SHIOON KIM DMD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-697-2777
Mailing Address - Street 1:19351 8TH AVE NE STE 211
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8710
Mailing Address - Country:US
Mailing Address - Phone:360-697-2777
Mailing Address - Fax:360-697-2711
Practice Address - Street 1:19351 8TH AVE NE STE 211
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8710
Practice Address - Country:US
Practice Address - Phone:360-697-2777
Practice Address - Fax:360-697-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASE000102431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty