Healthcare Provider Details

I. General information

NPI: 1023547130
Provider Name (Legal Business Name): WOO JIN PARK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 MERIDIAN AVE N
SEATTLE WA
98133
US

IV. Provider business mailing address

1200 12TH AVENUE SOUTH SUITE 901
SEATTLE WA
98144
US

V. Phone/Fax

Practice location:
  • Phone: 206-296-4990
  • Fax: 206-205-5142
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-762-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60867854
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: