Christopher Jin Park, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE60229142 Issued in WA

Practice address

16330 SE 256TH St
Covington, WA 98042-4233

Phone

(253) 246-7403

NPI assigned

Jun 23, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chris J. Lee, DMD, Chris J. Park, DDS, PLLC

  • Dental Clinic/Center
  • Covington, WA
  • NPI 1245612423
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436227200000",
    "number": "1013203405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16330 SE 256TH ST",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424233",
            "telephone_number": "253-246-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16330 SE 256TH ST",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424233",
            "telephone_number": "253-246-7403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "JIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-23",
        "last_updated": "2015-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60229142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxine Mae Tiu Pagan, PTRP, PT
• Sydney Bond Pahre, LMP
• Julia Gabrielle Paige
• Turen Pang
• Andrew Park, D.P.M.
• Hyun Jin Park, PHARMD
• Kristin A Park, DNP
• Elizabeth Parkhurst, DPT
• Jonathan Hugh Parks
• Caleb Pate

• Dentist in Covington, WA
• Providers in Covington, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.