Provider Demographics
NPI:1447085535
Name:KIM, JINKYU (LD)
Entity type:Individual
Prefix:
First Name:JINKYU
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 BETHEL RD SE # 2C
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-1976
Mailing Address - Country:US
Mailing Address - Phone:253-254-5069
Mailing Address - Fax:
Practice Address - Street 1:3965 BETHEL RD SE # 2C
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-1976
Practice Address - Country:US
Practice Address - Phone:253-254-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN61261599122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist