Active NPI
Tina Mieun Park-Lee, D.D.S.
- Dentist
- Loma Linda, CA
National Provider Identifier
1003037813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 40976
- Practice address
- 26554 Amherst CT
Loma Linda, CA 92354-6732 - Phone
- (909) 769-8077
- NPI assigned
- May 1, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 40976 | CA | Primary |
Addresses
Primary practice location
26554 Amherst CT
Loma Linda, CA 92354-6732
Mailing address
26554 Amherst CT
Loma Linda, CA 92354-6732
Phone (909) 769-8077
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C3701431 | Other | CA | DRIVER LISCENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378944000000",
"number": "1003037813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26554 AMHERST CT",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923546732",
"telephone_number": "909-769-8077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26554 AMHERST CT",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923546732",
"telephone_number": "909-769-8077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK-LEE",
"first_name": "TINA",
"middle_name": "MIEUN",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2013-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "40976",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LISCENCE",
"identifier": "C3701431",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.