# PRIME DENTAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407097850
- **Authorized official:** YONGJAE KIM DDS (MEMBER)
- **Authorized official phone:** (425) 457-3638

## Contact information

- **Practice address:** 302 WASHINGTON AVE S, KENT, WA 98032-5713
- **Practice address phone:** (253) 520-3866
- **Practice address fax:** (253) 520-3844
- **Mailing address:** PO BOX 4086, BELLEVUE, WA 98009-4086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00011115 | WA | — |
| 1223G0001X | General Practice Dentistry | DE00011116 | WA | Yes |

## Other

- **Enumeration date:** 03/16/2009
- **Last updated:** 10/22/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5059373 | — | WA |