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General NPI Number Information
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NPI Number | 1750796579
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Entity Type | Organization
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Legal Business Name | METROLIANCE FOOT AND ANKLE GROUP
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 2950 NORTHUP WAY SUITE #115
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City | BELLEVUE
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State | WA
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Zip | 98004-1406
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Country | US
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Telephone | 425-893-8100
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Fax | 425-893-8111
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Provider Business Mailing Address
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Address Line | 2950 NORTHUP WAY SUITE #115
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City | BELLEVUE
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State | WA
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Zip | 98004-1406
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Country | US
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Telephone | 425-893-8100
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Fax | 425-893-8111
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. TAESOON PARK
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Credential | DPM
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Telephone | 206-707-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO 60234756
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License Number State | WA
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