| Kim Jung Stevens Stevens Dds Ps | |
|
6001 100th St Sw Lakewood WA 98499 | |
| (253) 582-5050 | |
| (253) 582-5399 |
| Full Name | Kim Jung Stevens Stevens Dds Ps |
|---|---|
| Speciality | Dentist |
| Location | 6001 100th St Sw, Lakewood, Washington |
| Authorized Official Name and Position | Kevin T Kim (OWNER) |
| Authorized Official Contact | 2535825050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim Jung Stevens Stevens Dds Ps 6001 100th St Sw Lakewood WA 98499 Ph: (253) 582-5050 | Kim Jung Stevens Stevens Dds Ps 6001 100th St Sw Lakewood WA 98499 Ph: (253) 582-5050 |
| NPI Number | 1487747580 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 06/06/2018 |
| Medicare PECOS PAC ID | 0648521195 |
|---|---|
| Medicare Enrollment ID | O20180921000881 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487747580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3976 (Washington) | Primary |
| Provider Name | Kevin Tae-geol Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790848471 PECOS PAC ID: 1557612009 Enrollment ID: I20180921000968 |
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