Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000133 | WA |
NPI | 1447469747 |
---|---|
Provider Name | Seoung Hyon Park |
First Address | Lakewood, WA 98499 |
Second Address | Lakewood, WA 98499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |