Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN000312 | WA |
NPI | 1598882029 |
---|---|
Provider Name | Mr. Daniel I Park |
First Address | Federal Way, WA 98023-5235 |
Second Address | Federal Way, WA 98003-4902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5039128 | (05) | WA |