Organization
PRIME DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YONGJAE KIM DDS (MEMBER)
(425) 457-3638
Entity
Organization
Contact information
Practice address
302 WASHINGTON AVE S, KENT, WA 98032-5713
(253) 520-3866
(253) 520-3844
Mailing address
PO BOX 4086, BELLEVUE, WA 98009-4086
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DE00011115
WA
1223G0001X
General Practice Dentistry
Primary
DE00011116
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5059373
—
WA
Enumeration date
03/16/2009
Last updated
10/22/2009
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