Provider Demographics
NPI:1679995336
Name:VIAN, KIM (RDH)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:VIAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1373
Mailing Address - Country:US
Mailing Address - Phone:888-468-0022
Mailing Address - Fax:541-516-4059
Practice Address - Street 1:1289 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1373
Practice Address - Country:US
Practice Address - Phone:888-468-0022
Practice Address - Fax:541-516-4059
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6339124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist