Lisa Wysong Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00006876 Issued in WA

Practice address

3601 Fremont Ave N
316
Seattle, WA 98103

Phone

(206) 675-0366

Fax

(206) 675-0466

NPI assigned

Mar 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Lisa Hwa Park Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Lisa Park DDS & Simone Kim DDS

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1407001647
  NPD (past)

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487770715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 FREMONT AVE N",
            "address_2": "#316",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98103",
            "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": "316",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98103",
            "telephone_number": "206-675-0366",
            "fax_number": "206-675-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "LISA",
        "middle_name": "WYSONG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00006876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "PARK",
            "middle_name": "HWA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Juengsun Park, PHARMD
• Jung Sun Park
• Kathleen J Park, MD
• Kelly Park
• Lala Park, MD
• Louise M Park, ARNP
• Luke C. Park, D.D.S.
• Marian Park, MD
• Marie Ayabe Park
• Matthias Park

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, 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 Jul 8, 2007; 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.