Basic Information
| Provider Information | |||||||||
| NPI: | 1063931293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMURA | ||||||||
| FirstName: | TIFFANIE | ||||||||
| MiddleName: | P.O. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1424 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255511000 | ||||||||
| FaxNumber: | 4255511001 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 S STILLAGUAMISH AVE | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982231652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605725430 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 09/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH-1391 | HI | Y | Dental Providers | Dental Hygienist |
No ID Information.