Individual provider Active NPI

Donghyun Koo

  • Dentist
  • Seattle, WA
National Provider Identifier
1366875957
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE60822196 Issued in WA
Practice address
9776 Holman Rd NW Ste 110
Seattle, WA 98117-2000
Phone
(206) 783-3000
NPI assigned
Aug 19, 2013
Last updated
Jan 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE60822196 WA Primary

Addresses

Primary practice location

9776 Holman Rd NW Ste 110
Seattle, WA 98117-2000

Mailing address

8476 Simonds Street Ste 5700
Fort George G. Meade, MD 20755-5700
Phone (301) 677-6122

Other practice location 1

3900 E Valley Rd Ste 203
Renton, WA 98057-4954
Phone (425) 264-0044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE60822196WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Donghyun Koo DDS PC Dentist Current Accepting new patients
D Koo DDS PC CurrentSince Nov 22, 2020 Accepting new patients
D Koo PC PastSince Oct 13, 2024 Accepting new patients
Steven L. Paige DDS & Kenza Houki DMD Renton PLLC Past Accepting new patients

Locations

9776 Holman Rd NW
Ste 110
Seattle, WA 98117
Phone (206) 696-2322

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1366875957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8476 SIMONDS STREET STE 5700",
            "city": "FORT GEORGE G. MEADE",
            "state": "MD",
            "postal_code": "207555700",
            "telephone_number": "301-677-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9776 HOLMAN RD NW STE 110",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981172000",
            "telephone_number": "206-783-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 E Valley Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980574954",
            "country_code": "US",
            "telephone_number": "425-264-0044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOO",
        "first_name": "DONGHYUN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-19",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60822196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.