Organization
EVERLAST FAMILY DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUN J. PYEUN-KIM DMD (OWNER)
(253) 573-0070
Entity
Organization
Contact information
Practice address
1212 S 11TH ST STE 47, TACOMA, WA 98405-4021
(253) 573-0070
(253) 573-0272
Mailing address
1212 S 11TH ST STE 47, TACOMA, WA 98405-4021
(253) 573-0070
(253) 573-0272
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DE00010831
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5056478
—
WA
Enumeration date
04/14/2010
Last updated
04/14/2010
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