Chan Bae Kim, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

60483705 Issued in WA

Practice address

30640 Pacific Hwy S Ste a
Federal Way, WA 98003-4889

Phone

(253) 946-3895

NPI assigned

Nov 5, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Chan B Kim DDS PLLC

  • General Practice Dentistry
  • Federal Way, WA
  • NPI 1205784592
  NPD Authorized official

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

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1972804037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30640 PACIFIC HWY S STE A",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034889",
            "telephone_number": "253-946-3895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30640 PACIFIC HWY S STE A",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034889",
            "telephone_number": "253-946-3895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHAN",
        "middle_name": "BAE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-05",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "60483705",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6250",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59574",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kady Bridget Kilventon
• Kim & Lee Orthodontics
• Albert Edward Kim, D.D.S.
• Albert Hoonki Kim, MD
• Byung Rok Kim, MAOM, LAC
• Charles J Kim, DMD
• Christy Hyon Kim
• Daisy Y Kim, PT, DPT
• Daniel D Kim, PHARM.D.
• Doug Shin Kim, MD

• Dentist in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.