Provider Demographics
NPI:1114545886
Name:HOPE DENTAL, LLC
Entity Type:Organization
Organization Name:HOPE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNGSIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:216-762-6289
Mailing Address - Street 1:15515 JUANITA WOODINVILLE WAY NE UNIT K203
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-6104
Mailing Address - Country:US
Mailing Address - Phone:216-762-6289
Mailing Address - Fax:
Practice Address - Street 1:4713 168TH ST SW UNIT 102
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6813
Practice Address - Country:US
Practice Address - Phone:425-954-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty