Kyung Mook Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

27715 Issued in TX

Practice address

1034 N Willis St
Abilene, TX 79603-4622

Phone

(325) 673-8164

Fax

(325) 673-0812

NPI assigned

Mar 28, 2012

Sex

Male

Sole proprietor

No

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 TX

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

Networks

• NM HMO C-SNP
• TX HMO D-SNP

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.

• 817 Dental PLLC

  • General Practice Dentistry
  • Cleburne, TX
  • NPI 1699221036
  NPD
• Abbeville Dentistry - Abilene PLLC

  dba Smile Crafters Abilene

  • General Practice Dentistry
  • Abilene, TX
  • NPI 1871971317
  NPD (past)
• Abilene Smilecrafters, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Abilene, TX
  • NPI 1215266093
  NPD (past)

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1013283613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 N WILLIS ST",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796034622",
            "telephone_number": "325-673-8164",
            "fax_number": "325-673-0812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N WILLIS ST",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796034622",
            "telephone_number": "325-673-8164",
            "fax_number": "325-673-0812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYUNG",
        "middle_name": "MOOK",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-28",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "27715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley P Pape
• Michael Tanner Pape, DPT
• Kim L Parish, PT
• Albert Christopher Park, DDS
• Caroline Park, LPC
• Clevis T. Parker Sr., MD
• Padgett Parker, PA-C
• Robert Parkhill, LCSW
• Kamie Erin Parks, RN,NP-C
• Daryn Heath Parnell, LAT

• General Practice Dentistry in Abilene, TX
• Providers in Abilene, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; 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.