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General NPI Number Information
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NPI Number | 1104150473
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Entity Type | Organization
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Legal Business Name | HYUN S. PARK DDS, PS
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Dates
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Enumeration Date | 09/19/2009
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Last Update Date | 09/19/2009
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Provider Practice Location Address
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Address Line | 1717 S 324TH ST STE A
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8500
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Country | US
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Telephone | 253-815-0093
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 S 324TH ST STE A
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8500
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Country | US
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Telephone | 253-815-0093
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HYUN S PARK
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Credential | DDS
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Telephone | 253-815-0093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE7278
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License Number State | WA
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