MEDICARE: DR. GREGORY PARK CHINN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE00010426	WA

General Provider Information

NPI Number	:	1235114943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY PARK CHINN D.D.S.

Provider Business Mailing Address
First Line	:	7311 39TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2102
Country	:	US
Telephone Number	:	206-290-7288
Fax Number	:

Provider Business Practice Location Address
First Line	:	7311 39TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2102
Country	:	US
Telephone Number	:	206-290-7288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	03/05/2019

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