Organization
SUSAN KIM DDS
Active
Other names
Evergreen Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN S KIM DDS (PRESIDENT)
(425) 814-3196
Entity
Organization
Contact information
Practice address
12910 TOTEM LAKE BLVD NE STE 103, KIRKLAND, WA 98034
(425) 814-3196
(425) 825-9646
Mailing address
12910 TOTEM LAKE BLVD NE STE 103, KIRKLAND, WA 98034-2901
(425) 814-3196
(425) 825-9646
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9731
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5048368
—
WA
Enumeration date
04/11/2006
Last updated
07/17/2018
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