Kim & Cervantes-Kim DDS PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KIM & CERVANTES-KIM DDS PLLC

Doing business as

Elliott Bay Dental

Practice address

945 Elliott Ave W Ste 212
Seattle, WA 98119-3645

Phone

(206) 812-7957

Fax

(206) 812-9506

NPI assigned

Oct 27, 2020

Last updated

Oct 27, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Misty Cervantes-Kim, DDS

Title

Owner/Dentist

Phone

(206) 812-7957

Specialties & licenses 1

Addresses

Other names 1

• Elliott Bay Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Misty Ann Cervantes, DDS

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1689750739
  NPD
• Jaimie Kwon

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1851844427
  NPD (past)

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1730789082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 ELLIOTT AVE W STE 212",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981193645",
            "telephone_number": "206-812-7957",
            "fax_number": "206-812-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 ELLIOTT AVE W STE 212",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981193645",
            "telephone_number": "206-812-7957",
            "fax_number": "206-812-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM & CERVANTES-KIM DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "CERVANTES-KIM",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "206-812-7957",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elliott Bay Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joel Johnson Killough
• Lindsay M Killpack
• Clay Kilpatrick
• Kilted Counseling
• Pamela J. Kiltz, OTR/L
• Kim Okamura DDS
• Kim S. Mallick, M.D., P.S.
• Lauren Kim Sing, MD
• Jessie Kim-Deobald, MD
• Sally H. Kim-Miller, M.D.

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; 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.