Kim A Walter, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE00005339 Issued in WA

Practice address

16306 Bothell Everett Hwy
Ste 2
Mill Creek, WA 98012-1283

Phone

(425) 745-4661

NPI assigned

May 23, 2005

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Mill Creek Dentist

  • General Practice Dentistry
  • Mill Creek, WA
  • NPI 1205209913
  NPD (past) Authorized official
• Sam Chong, DDS, P.L.L.C.

  dba The Mill Creek Dentist

  • General Practice Dentistry
  • Mill Creek, WA
  • NPI 1316780877
  NPD (past)

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1962405969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16306 BOTHELL EVERETT HWY",
            "address_2": "STE 2",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121283",
            "telephone_number": "425-745-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16306 BOTHELL EVERETT HWY",
            "address_2": "STE 2",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121283",
            "telephone_number": "425-745-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "KIM",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00005339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5015508",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Scott Wagner, OD
• Matthew Wah, PT
• Dariusz Walczak, MD
• Karen L Wallace, RD, CD
• Nicole Michelle Walsh, LMP
• Jennifer J Walters, ND
• Christina Wang, O.D.
• Jason Wang
• Washington CVS Pharmacy LLC (CVS Pharmacy #11650)
• Washington Physical Therapy Services of Mill Creek, LLC (Apex Health And Rehab)

• Dentist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.