# LISA PARK DDS & SIMONE KIM DDS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fremont Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407001647
- **Authorized official:** SIMONE KIM DDS (CO-OWNER)
- **Authorized official phone:** (206) 675-0366

## Contact information

- **Practice address:** 3601 FREMONT AVE N, SUITE 316, SEATTLE, WA 98103-2709
- **Practice address phone:** (206) 675-0366
- **Practice address fax:** (206) 675-0466
- **Mailing address:** 3601 FREMONT AVE N, SUITE 316, SEATTLE, WA 98103-2709
- **Mailing address phone:** (206) 675-0366
- **Mailing address fax:** (206) 675-0466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 743094945 | WA | Yes |
| 1223G0001X | General Practice Dentistry | 743094948 | WA | — |

## Other

- **Enumeration date:** 12/01/2008
- **Last updated:** 12/01/2008