SONG PERIODONTICS (NPI# 1386202539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386202539 |
| Entity Type | Organization |
| Organization Name | SONG PERIODONTICS |
| Practice Address |
21807 76th Ave W Edmonds WA 98026-7938 |
| Mailing Address |
21807 76th Ave W Ste 1 Edmonds WA 98026-7938 |
| Practice Telephone | 4257752002 |
| Practice Fax Number | 4257752004 |
| Mailing Telephone | 4257752002 |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-06-03 |
| Authorized Official Name | DR. HYUN SONG (DENTIST) |
| Authorized Official Telephone | 4257752002 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | SONG PERIODONTICS AND DENTAL IMPLANTS PLLC | 21807 76th Ave W Ste 1, Suite 1, Edmonds, WA 98026-7938 |
| Street Address |
21807 76TH AVE W |
| City | EDMONDS |
| State | WA |
| Zip Code | 98026-7938 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295760585 | Hyun Jung Song | Dentist | 21807 76th Ave W, Edmonds, WA 98026 | 2006-07-12 |
| 1093948267 | Clark Kenneth Kvistad | Dentist | 21807 76th Ave W, Edmonds, WA 98026-7938 | 2009-09-03 |
| 1790874758 | Justin M Pagan | Dentist | 21807 76th Ave W, Edmonds, WA 98026-7938 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833526 | Enas Hamid Albar | Student in an Organized Health Care Education/Training Program | 7500 212th Street S.w., Suite 205, Edmonds, WA 98026 | 2020-08-26 |
| 1215579453 | Kailey Anne Matulich | Technician | 21630 84th Ave W, Edmonds, WA 98026 | 2019-10-09 |
| 1154962124 | Steven M Weible | Technician | 21630 84th Ave, Edmonds, WA 98026 | 2019-10-01 |
| 1053767293 | Hyo Kyung Kim | Pharmacist | 22618 Hwy 99 Ste 109, Edmonds, WA 98026 | 2016-05-06 |
| 1679947956 | Lucilyn Lumio | Occupational Therapist | 21008 76th Avenue W, Edmonds, WA 98026 | 2015-11-24 |
| 1669844205 | Kathleen Schmitt | Pharmacist | 21601 76th Ave West, Edmonds, WA 98026 | 2015-10-22 |
| 1689087967 | Ronald Paul Meagher | Anesthesiology | 7305 173rd St Sw, Edmonds, WA 98026 | 2014-06-04 |
| 1598194342 | Allison Alberton | Surgery | 7315 212th St Sw Ste 201, Edmonds, WA 98026 | 2013-11-02 |
| 1356681019 | Tekle Zewolday Eysadik | Registered Nurse | 8102 - 226 St Sw, Edmonds, WA 98026 | 2013-02-18 |
| 1447557087 | Diane Taylor | Counselor | 20903 70th Ave W., Edmonds, WA 98026 | 2011-02-17 |
| Find all providers in zip 98026 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912095969 | Betsy Rocio Mosquera | Dentist | 9307 244th St Sw Apt L303, Edmonds, WA 98020-7502 | 2006-10-11 |
| 1295760585 | Hyun Jung Song | Dentist | 21807 76th Ave W, Edmonds, WA 98026 | 2006-07-12 |
| 1093948267 | Clark Kenneth Kvistad | Dentist | 21807 76th Ave W, Edmonds, WA 98026-7938 | 2009-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225653397 | Rika Takada | Dentist | B403 Health Sciences Building, Seattle, WA 98195-0001 | 2020-06-14 |
| 1467074757 | Amit Srikant Gharpure | Dentist | 1959 Ne Pacific Street Health Science Center Room B-403, Seattle, WA 98195-0001 | 2020-05-10 |
| 1922632843 | Jessica Hsu | Dentist | 625 4th Ave Ste 201, Kirkland, WA 98033-9028 | 2020-02-29 |
| 1992338891 | Ehsan Zahedi | Dentist | 18009 Highway 99 Ste F, Lynnwood, WA 98037-4499 | 2020-02-19 |
| 1780142729 | Shoko Sato | Dentist | 2505 S 320th St Ste 330, Federal Way, WA 98003-5461 | 2019-03-08 |
| 1942738497 | Yu Lwo | Dentist | 1740 Nw Maple St Ste 110, Issaquah, WA 98027-8000 | 2017-05-30 |
| 1134677792 | Mill Creek Implants & Periodontics | Dentist | 15130 Main St Ste 210, Mill Creek, WA 98012-7370 | 2016-09-13 |
| 1164890026 | Shih-chung Liao | Dentist | 720 Olive Way Ste 810, Seattle, WA 98101-1836 | 2015-09-09 |
| 1225445539 | Implant & Periodontic Specialists | Dentist | 1418 112th Ave Ne Suite 100, Bellevue, WA 98004 | 2014-07-18 |
| 1093147068 | Etheridge Family Dentistry | Dentist | 3130 E Madison St Ste 103, Seattle, WA 98112-4221 | 2013-08-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.