Minh Dau, DDS and Raymond Park, DDS PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE60467195 Issued in WA

Legal business name

MINH DAU, DDS AND RAYMOND PARK, DDS PLLC

Practice address

3105 Alderwood Mall Blvd
Suite 117
Lynnwood, WA 98036-4703

Phone

(425) 284-9886

NPI assigned

Apr 20, 2017

Organization subpart

No

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

Authorized official

Name

Raymond ParkNPI 1548521248

Title

Governor

Phone

(425) 284-9886

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raymond B Park, DDS

  • Pediatric Dentistry
  • Lynnwood, WA
  • NPI 1548521248
  NPD (past) Authorized official
• Minh Quang Dau, D.D.S.

  • Pediatric Dentistry
  • Boston, MA
  • NPI 1861743205
  NPD (past)

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1831624402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 ALDERWOOD MALL BLVD",
            "address_2": "SUITE 117",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364703",
            "telephone_number": "425-284-9886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 ALDERWOOD MALL BLVD",
            "address_2": "SUITE 117",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364703",
            "telephone_number": "425-284-9886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINH DAU, DDS AND RAYMOND PARK, DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "GOVERNOR",
        "authorized_official_telephone_number": "425-284-9886"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60467195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861743205",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548521248",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelyn Sue Milligan, M.S., CCC-SLP
• Byung Ho Min
• June Min, L AC
• Roberta Mina
• Mindful Movement Physical Therapy, LLC
• Mipa Corp
• Mira Aqua Massage
• Debra Leigh Miranda, VA00021259
• Ehan Mirza
• Liliya Mikhaylovna Miskova

• Pediatric Dentistry in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.