Park, Young Bae
Park, Young Bae is an sole proprietor health care provider with primary practice located at 11120 Evergreen Way #G, Everett WA 98204-3888. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Park, Young Bae can be contacted via phone (425) 265-1188.Contact Information
Primary practice address
11120 Evergreen Way #G
Everett WA 98204-3888
Phone: (425) 265-1188
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | DE7465 | Washington |
Profile Details
| NPI number | 1568597912 |
|---|---|
| LBN Legal business name | Park, Young Bae |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 23rd, 2007 |
| Last updated | Jun 18th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568597912 | NPPES |
| Washington | MEDICAID | 33-1093673 |
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