Wonpyo Eric Park, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

56613 Issued in CA

Practice address

11851 South St
Cerritos, CA 90703-6825

Phone

(562) 809-8911

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Ta-Wei Huang DDS, Inc.

  • Dental Clinic/Center
  • Cerritos, CA
  • NPI 1952034381
  NPD
• Yang'S Dental Clinic

  • Dental Clinic/Center
  • Cerritos, CA
  • NPI 1568026888
  NPD (past)

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1033257233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 AVENIDA DEL NORTE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928331820",
            "telephone_number": "714-656-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11851 SOUTH ST",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907036825",
            "telephone_number": "562-809-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "WONPYO",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00010771",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4956T",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Yoon Gaahee Park, PA-C
• John Bansuk Park, PHARM.D.
• June Park
• Juntae Park, LA.C
• Sae Hee Park, N.P.
• Jacquiece Parker
• Anne Allcott Parkford, MFT
• Melessia Marie Partis
• Katelyn Parton, FNP-BC
• Clarisa Paschall

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.