John Woongjoon Park, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DE00011114 Issued in WA

Practice address

3866 S 74TH St Ste 200
Tacoma, WA 98409-9908

Phone

(855) 433-6825

NPI assigned

Nov 28, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

State licenses

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.

• Willamette Dental Group, P.C.

  • Dentist
  • Lacey, WA
  • NPI 1679409684
  NPD (past)
• Willamette Dental Group, P.C.

  • Dentist
  • Tacoma, WA
  • NPI 1881520880
  NPD (past)

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

{
    "created_epoch": "1259366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1265760474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3866 S 74TH ST STE 200",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984099908",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3773-C martin way",
            "address_purpose": "LOCATION",
            "city": "olympia",
            "state": "WA",
            "postal_code": "98506",
            "country_code": "US",
            "telephone_number": "360-456-3638",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4550 3rd Ave SE",
            "address_purpose": "LOCATION",
            "city": "Lacey",
            "state": "WA",
            "postal_code": "985031033",
            "country_code": "US",
            "telephone_number": "855-433-6825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOHN",
        "middle_name": "WOONGJOON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-28",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D-4283-PE",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE00011114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hoon Park, DC, L.AC
• Isabella Park
• Jason Park
• Jesse Park
• Jina Park
• Juyeon Park, MSW STUDENT
• Juyoung Park
• Lawrence Soo-Young Park, MD
• Matthew V. Park, M.D.
• Michael Park

• Periodontics in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.