NPIMap

Organization Active NPI

Crystal Dental Inc.

  • General Practice Dentistry
  • Renton, WA
National Provider Identifier
1184047466
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE60389882 Issued in WA
Legal business name
CRYSTAL DENTAL INC.
Practice address
12644 164TH Ave SE
Renton, WA 98059-6403
Phone
(425) 282-4182
Fax
(425) 572-6072
NPI assigned
Jan 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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

Authorized official

Name
Dr. Chris Joon Lee, DMDNPI 1962824730
Title
Dentist
Phone
(425) 282-4182

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DE60389882 WA Primary

Addresses

Primary practice location

12644 164TH Ave SE
Renton, WA 98059-6403

Mailing address

12644 164TH Ave SE
Renton, WA 98059-6403
Phone (425) 282-4182

National Provider Directory

National Provider Directory

Locations

12644 164th Ave SE
Renton, WA 98059
Phone (425) 282-4182

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1390435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1184047466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12644 164TH AVE SE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980596403",
            "telephone_number": "425-282-4182",
            "fax_number": "425-572-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12644 164TH AVE SE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980596403",
            "telephone_number": "425-282-4182",
            "fax_number": "425-572-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-23",
        "last_updated": "2014-01-23",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "JOON",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "425-282-4182",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60389882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.