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General NPI Number Information
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NPI Number | 1114545886
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Entity Type | Organization
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Legal Business Name | HOPE DENTAL, LLC
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 4713 168TH ST SW UNIT 102
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City | LYNNWOOD
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State | WA
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Zip | 98037-6813
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Country | US
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Telephone | 425-954-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 15515 JUANITA WOODINVILLE WAY NE UNIT K203
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City | BOTHELL
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State | WA
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Zip | 98011-6104
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Country | US
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Telephone | 216-762-6289
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KYUNGSIK MOON
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Credential | DMD
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Telephone | 216-762-6289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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