EVERGREEN PEDIATRIC DENTISTRY
NPI 1265495196
Dentist - Pediatric Dentistry in Kirkland, WA

Q: What is Susan Kim Dds's NPI number?

The NPI number for Susan Kim Dds is 1265495196. It was assigned to this organization in the NPPES registry on April 11, 2006. The provider is doing business as Evergreen Pediatric Dentistry.

Q: What is Susan Kim Dds's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Susan Kim Dds was last updated on July 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 11, 2006

12910 TOTEM LAKE BLVD NE STE 103, KIRKLAND, WA 98034(425) 814-3196(425) 825-9646 Get Directions Write a Review

NPPES record last updated: July 17, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Evergreen Pediatric Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN PEDIATRIC DENTISTRY (NPI 1265495196) is a healthcare organization registered as a pediatric dentistry in Kirkland, Washington and active in the NPI registry since April 2006. The organization lists Susan S Kim, President, as its authorized official.

NPPES Registry Identity

NPI1265495196

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NameSUSAN KIM DDS

Location Address12910 TOTEM LAKE BLVD NE STE 103Kirkland, WA 98034

Mailing Address12910 Totem Lake Blvd Ne Ste 103Kirkland, WA 98034-2901 · (425) 814-3196 · Fax (425) 825-9646

Phone(425) 814-3196

Fax(425) 825-9646

Organization SubpartNo

Authorized OfficialSusan S KimPresident · (425) 814-3196

Enumeration DateApril 11, 2006

Last NPPES UpdateJuly 17, 2018

✔ NPI 1265495196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

License✔ Licensed in WA · 9731

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

12910 TOTEM LAKE BLVD NE STE 103, Kirkland, WA 98034

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Other Names 1

Doing Business AsEvergreen Pediatric Dentistry

Other Identifiers 1

Medicaid5048368WA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susan Kim Dds's NPI number?

The NPI number for Susan Kim Dds is 1265495196. It was assigned to this organization in the NPPES registry on April 11, 2006. The provider is doing business as Evergreen Pediatric Dentistry.

Where is Susan Kim Dds located?

Susan Kim Dds is located at 12910 Totem Lake Blvd NE Ste 103, Kirkland, WA 98034. The listed phone number is (425) 814-3196.

What is Susan Kim Dds's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Susan Kim Dds was last updated on July 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.