NPIMap

Organization Active NPI

Lisa Park DDS & Simone Kim DDS

  • General Practice Dentistry
  • Seattle, WA
National Provider Identifier
1407001647
Registry record updated Dec 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
743094945 Issued in WA
Legal business name
LISA PARK DDS & SIMONE KIM DDS
Practice address
3601 Fremont Ave N
Suite 316
Seattle, WA 98103-2709
Phone
(206) 675-0366
Fax
(206) 675-0466
NPI assigned
Dec 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2008

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

Authorized official

Name
Simone Kim, DDSNPI 1518089234
Title
Co-Owner
Phone
(206) 675-0366

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 743094945 WA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 743094948 WA

Addresses

Primary practice location

3601 Fremont Ave N
Suite 316
Seattle, WA 98103-2709

Mailing address

3601 Fremont Ave N
Suite 316
Seattle, WA 98103-2709
Phone (206) 675-0366

Other names 1

  • Fremont Dental Other name

National Provider Directory

National Provider Directory

Locations

3601 Fremont Ave N
Ste 316
Seattle, WA 98103
Phone (206) 675-0366

Practitioners & affiliated clinicians

Practitioners 2

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": "1228089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228089600000",
    "number": "1407001647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 FREMONT AVE N",
            "address_2": "SUITE 316",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981032709",
            "telephone_number": "206-675-0366",
            "fax_number": "206-675-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 FREMONT AVE N",
            "address_2": "SUITE 316",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981032709",
            "telephone_number": "206-675-0366",
            "fax_number": "206-675-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA PARK DDS & SIMONE KIM DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-01",
        "last_updated": "2008-12-01",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SIMONE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "206-675-0366",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "743094945",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "743094948",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fremont Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; 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.