NPIMap

Organization Active NPI

Dae Ho Kim DDS PC Inc

  • Dentist
  • Everett, WA
National Provider Identifier
1386053973
Registry record updated Aug 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
60307878 Issued in WA
Legal business name
DAE HO KIM DDS PC INC
Practice address
5929 Evergreen Way
Suite 100
Everett, WA 98203-6031
Phone
(425) 353-4469
NPI assigned
Aug 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dae Ho Kim, DDS
Title
President/Dentist
Phone
(425) 353-4469

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 60307878 WA Primary

Addresses

Primary practice location

5929 Evergreen Way
Suite 100
Everett, WA 98203-6031

Mailing address

5929 Evergreen Way
Suite 100
Everett, WA 98203-6031
Phone (425) 353-4469

Other names 1

  • Chicago Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

5929 Evergreen Way
Ste 100
Everett, WA 98203
Phone (425) 353-4469

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407369600000",
    "number": "1386053973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5929 EVERGREEN WAY",
            "address_2": "SUITE 100",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036031",
            "telephone_number": "425-353-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5929 EVERGREEN WAY",
            "address_2": "SUITE 100",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036031",
            "telephone_number": "425-353-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAE HO KIM DDS PC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DAE",
        "authorized_official_middle_name": "HO",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "425-353-4469",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "60307878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chicago Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.