SE Won An, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE61092968 Issued in WA

Practice address

3104 S Union Ave
Tacoma, WA 98409-3330

Phone

(253) 761-3000

NPI assigned

Oct 22, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• SE Won an, DDS, PLLC

  • Dental Clinic/Center
  • Tacoma, WA
  • NPI 1912745795
  NPD Authorized official
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Everett, WA
  • NPI 1477911410

  Dentist

  NPD
• Jae H Kim DDS PLLC

  • General Practice Dentistry
  • Kirkland, WA
  • NPI 1528907813
  NPD (past)
• Kirkland Cornerstone Dental

  • General Practice Dentistry
  • Kirkland, WA
  • NPI 1174385082
  NPD (past)

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1285233023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 100TH ST SE STE C2",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083832",
            "telephone_number": "425-249-0770",
            "fax_number": "425-249-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 S UNION AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984093330",
            "telephone_number": "253-761-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1920 100th St SE Ste C2",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982083832",
            "country_code": "US",
            "telephone_number": "425-249-0770 x67150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AN",
        "first_name": "SE WON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-22",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61092968",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61092968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul J Amoroso, MD, MPH
• Chauntel Amos
• Cassandra Bunighruk Amouak-Hale, DPT
• Isabelle Amundsen
• Hyojae An, DDS
• Anand Pullat DDS PLLC
• Anand Pullat DDS PLLC
• Erika M Anattol, ATC
• Anchorbridge Assessments and Referrals LLC
• Nicole M Ancich, DMD

• General Practice Dentistry in Tacoma, WA
• Providers in Tacoma, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.