NPIMap

Organization Active NPI

Young B Park, DDS, PS

  • General Practice Dentistry
  • Everett, WA
National Provider Identifier
1487979092
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE7465 Issued in WA
Legal business name
YOUNG B PARK, DDS, PS
Doing business as
Young Dental Care
Practice address
11120 Evergreen Way
Suite G
Everett, WA 98204
Phone
(425) 265-1188
Fax
(425) 265-1619
NPI assigned
Apr 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Authorized official

Name
Young Bae Park, DDSNPI 1568597912
Title
Dentist/President
Phone
(425) 265-1188

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DE7465 WA Primary

Addresses

Primary practice location

11120 Evergreen Way
Suite G
Everett, WA 98204

Mailing address

11120 Evergreen Way
Suit G
Everett, WA 98204
Phone (425) 265-1188

Other names 1

  • Young Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

11120 Evergreen Way
Ste G
Everett, WA 98204
Phone (425) 265-1188

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": "1270598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1487979092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11120 EVERGREEN WAY",
            "address_2": "SUIT G",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98204",
            "telephone_number": "425-265-1188",
            "fax_number": "425-265-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11120 EVERGREEN WAY",
            "address_2": "SUITE G",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98204",
            "telephone_number": "425-265-1188",
            "fax_number": "425-265-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUNG B PARK, DDS, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "BAE",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "425-265-1188",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE7465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; 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.