Daniel Ilwoo Park, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60240620 Issued in WA

Practice address

15433 Country Club Dr
Unit A206
Mill Creek, WA 98012-1260

Phone

(425) 890-5857

NPI assigned

Aug 10, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1699054577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13524",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980821524",
            "telephone_number": "425-890-5857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15433 COUNTRY CLUB DR",
            "address_2": "UNIT A206",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121260",
            "telephone_number": "425-890-5857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DANIEL",
        "middle_name": "ILWOO",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60240620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon J Orr, MD
• Kateryna Ovechko
• Kristin Overman, LMHC
• Geneva Lorraine Padilla, R.N.
• Tisha Pae
• Hyunhee Park, D.O.
• Holli Kristine Parker, L.M.P.
• Paul H. Krzeszowski DDS PLLC
• Paul S. Kahlon, PLLC
• Pediatric Associates, Inc., P.S. Dba Allegro Pediatrics

• Massage Therapist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; 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.