=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174385082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIRKLAND CORNERSTONE DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2024
-----------------------------------------------------
Last Update Date | 01/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7311 NE 141ST ST STE 2
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-9703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-823-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7311 NE 141ST ST STE 2
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-9703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-823-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. YONG CHOI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 425-823-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------