Evergreen Pediatric Dentistry

LBN: Susan Kim Dds
Evergreen Pediatric Dentistry is an health care organization with primary practice located at 12910 Totem Lake Blvd Ne Ste 103 , Kirkland WA 98034. The organization recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as the primary health care specialty. Susan Kim Dds can be contacted via phone (425) 814-3196, or through Kim, Susan S via phone (425) 814-3196.

Contact Information

Primary practice address
12910 Totem Lake Blvd Ne Ste 103 Kirkland WA 98034
Phone: (425) 814-3196
Fax: (425) 825-9646
Website:
Map and Directions
Authorized official contact:
Name: Kim, Susan S Doctor of Dental Surgery (DDS)
Phone: (425) 814-3196

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 9731 Washington

Profile Details

NPI number 1265495196
LBN Legal business name Susan Kim Dds
DBA Doing business as Evergreen Pediatric Dentistry
Authorized official Kim, Susan S Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 11th, 2006
Last updated Jul 17th, 2018 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265495196 NPPES
Washington MEDICAID 5048368

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