MEDICARE: DR. LUKE C. PARK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE 60230309	WA

General Provider Information

NPI Number	:	1871799650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUKE C. PARK D.D.S.

Provider Business Mailing Address
First Line	:	1020 SW 339TH ST
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98023-7891
Country	:	US
Telephone Number	:	818-621-5942
Fax Number	:

Provider Business Practice Location Address
First Line	:	3255 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3304
Country	:	US
Telephone Number	:	206-935-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	02/26/2015

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