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General NPI Number Information
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NPI Number | 1245612423
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Entity Type | Organization
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Legal Business Name | CHRIS J. LEE, DMD, CHRIS J. PARK, DDS, PLLC
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 16330 SE 256TH ST
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City | COVINGTON
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State | WA
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Zip | 98042-4233
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Country | US
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Telephone | 206-245-3349
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Fax |
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Provider Business Mailing Address
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Address Line | 10610 NE 9TH PL UNIT 1103
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City | BELLEVUE
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State | WA
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Zip | 98004-8640
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Country | US
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Telephone | 206-245-3349
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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. CHRISTOPHER JIN PARK
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Credential | DDS
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Telephone | 206-245-3349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60229142
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License Number State | WA
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