DR. HOSAN PARK (NPI# 1104363019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104363019 |
| Entity Type | Individual |
| Full Name | DR. HOSAN PARK |
| Credential | D.D.S |
| Practice Address |
25610 104th Ave Se Kent WA 98030-7610 |
| Mailing Address |
2144 9th Ave W Seattle WA 98119-2843 |
| Practice Telephone | 2538509777 |
| Mailing Telephone | 9172267669 |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2018-04-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0300X |
Dentist Specialization: Periodontics |
019.031420 | IL | Dental Providers |
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
DE60722033 | WA | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9730 3rd Ave Ne Ste 205, Seattle, WA 981152023 | 2063676453 |
| Street Address |
25610 104TH AVE SE |
| City | KENT |
| State | WA |
| Zip Code | 98030-7610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144393893 | Benjamin Dorantes | Dentist | 25610 104th Ave Se, Kent, WA 98030-7610 | 2006-11-17 |
| 1447636618 | Julie Kim | Dentist | 25610 104th Ave Se, Kent, WA 98030-7610 | 2015-08-10 |
| 1053756049 | Nurani, Mitchell, Kim, PC | Dentist | 25610 104th Ave Se, Kent, WA 98030-7610 | 2013-05-03 |
| 1063726719 | Peter K Chung | Dentist | 25610 104th Ave Se, Kent, WA 98030-7610 | 2010-08-04 |
| 1376607465 | Thomas Faber | Dentist | 25610 104th Ave Se, Kent, WA 98030-7610 | 2006-12-21 |
| 1104999853 | Tameem A Anwar | Dentist | 25610 104th Ave Se, Kent, WA 98030-7610 | 2006-11-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871193193 | Sarah V Swan | Occupational Therapist | 12033 Se 265th St, Kent, WA 98030 | 2020-10-27 |
| 1346889250 | Kaylee Meilahn | Nurse Practitioner | 219 State Ave. N, Suite 220, Kent, WA 98030 | 2019-12-26 |
| 1508417429 | Pamela Stefansky | Technician | 25927 119th Ct Se, Kent, WA 98030 | 2019-09-23 |
| 1144703885 | Healthpoint | Clinic/Center | 219 State Ave N, Ste 100, Kent, WA 98030 | 2018-09-10 |
| 1932681921 | Johana Sanchez-vidales | Massage Therapist | 24837 104th Ave Se #100, Kent, WA 98030 | 2018-09-05 |
| 1265925309 | Linda Tomkins | Chiropractor | 12901 Se Kent-kangley Rd, Kent, WA 98030 | 2018-06-13 |
| 1952809543 | Sarah Rose Collins | Massage Therapist | 13003 Se Kent Kangley Rd Ste 110, Kent, WA 98030 | 2018-01-29 |
| 1942726815 | Alexandra B Zigmont | Physical Therapist | 12926 Se Kent Kangley Road, Kent, WA 98030 | 2017-08-22 |
| 1659801256 | Mitra Lal Dhital | Counselor | 3639 Mlk Jr Way S Seattle, Seattle, WA 98030 | 2017-06-15 |
| 1952838658 | Elizabeth Burson | Registered Nurse | 25742 104th Avenue Se, Kent, WA 98030 | 2017-05-12 |
| Find all providers in zip 98030 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689617896 | Jen-tai Jeremy Chen | Dentist | 221 2nd Ave S, #101, Kent, WA 98032-5873 | 2006-06-14 |
| 1376607465 | Thomas Faber | Dentist | 25610 104th Ave Se, Kent, WA 98030-7610 | 2006-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225653397 | Rika Takada | Dentist | B403 Health Sciences Building, Seattle, WA 98195-0001 | 2020-06-14 |
| 1467074757 | Amit Srikant Gharpure | Dentist | 1959 Ne Pacific Street Health Science Center Room B-403, Seattle, WA 98195-0001 | 2020-05-10 |
| 1922632843 | Jessica Hsu | Dentist | 625 4th Ave Ste 201, Kirkland, WA 98033-9028 | 2020-02-29 |
| 1992338891 | Ehsan Zahedi | Dentist | 18009 Highway 99 Ste F, Lynnwood, WA 98037-4499 | 2020-02-19 |
| 1780142729 | Shoko Sato | Dentist | 2505 S 320th St Ste 330, Federal Way, WA 98003-5461 | 2019-03-08 |
| 1942738497 | Yu Lwo | Dentist | 1740 Nw Maple St Ste 110, Issaquah, WA 98027-8000 | 2017-05-30 |
| 1134677792 | Mill Creek Implants & Periodontics | Dentist | 15130 Main St Ste 210, Mill Creek, WA 98012-7370 | 2016-09-13 |
| 1164890026 | Shih-chung Liao | Dentist | 720 Olive Way Ste 810, Seattle, WA 98101-1836 | 2015-09-09 |
| 1225445539 | Implant & Periodontic Specialists | Dentist | 1418 112th Ave Ne Suite 100, Bellevue, WA 98004 | 2014-07-18 |
| 1093147068 | Etheridge Family Dentistry | Dentist | 3130 E Madison St Ste 103, Seattle, WA 98112-4221 | 2013-08-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.