Active NPI
Joonil Park, D.M.D.
- Dentist
- Federal Way, WA
National Provider Identifier
1649552571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60232756
- Practice address
- 30620 Pacific Hwy S Ste 111
Federal Way, WA 98003-4888 - Phone
- (253) 946-3895
- NPI assigned
- Sep 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60232756 | WA | Primary |
Addresses
Primary practice location
30620 Pacific Hwy S Ste 111
Federal Way, WA 98003-4888
Mailing address
457 NE Thornton PL
Seattle, WA 98125-8022
Phone (857) 891-5391
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150922002429 | WA | Order and Referring Only - Dentist | 7810204989 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329868800000",
"number": "1649552571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "457 NE THORNTON PL",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981258022",
"telephone_number": "857-891-5391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30620 PACIFIC HWY S STE 111",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980034888",
"telephone_number": "253-946-3895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JOONIL",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-16",
"last_updated": "2012-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60232756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Federal Way, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.