Provider Demographics
NPI:1790817005
Name:PAPER STREET PERIODONTICS & IMPLANT DENTRISTRY
Entity Type:Organization
Organization Name:PAPER STREET PERIODONTICS & IMPLANT DENTRISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-400-0800
Mailing Address - Street 1:2505 S 320TH ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5400
Mailing Address - Country:US
Mailing Address - Phone:206-400-0800
Mailing Address - Fax:253-874-9068
Practice Address - Street 1:2505 S 320TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5400
Practice Address - Country:US
Practice Address - Phone:206-400-0800
Practice Address - Fax:253-874-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00010542OtherSTATE LICENSE