Kyungsin Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

56339 Issued in CA

Practice address

285 E Alessandro Blvd
Ste 7D
Riverside, CA 92508-5083

Phone

(951) 780-9800

Fax

(951) 780-3267

NPI assigned

Feb 7, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jihee Chun DDS, Inc

  • Dental Clinic/Center
  • Covina, CA
  • NPI 1124160452
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324857600000",
    "number": "1003094426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 E ALESSANDRO BLVD",
            "address_2": "STE 7D",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925085083",
            "telephone_number": "951-780-9800",
            "fax_number": "951-780-3267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 E ALESSANDRO BLVD",
            "address_2": "STE 7D",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925085083",
            "telephone_number": "951-780-9800",
            "fax_number": "951-780-3267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYUNGSIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-07",
        "last_updated": "2011-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Jinho Park, MD
• Jim Sang Park, D.D.S
• Jin Hwi Park, DDS
• Jong Min Park, PHARMD.
• Julie Son Park
• Melissa Park, RN
• Myung Kee Park, DDS
• Nathaniel Park, MD
• Sherie L Park, LMFT
• Vanessa Ceballos Park, O.D.

• Dentist in Riverside, CA
• Providers in Riverside, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.