Active NPI
Annie Youngeun Park, DDS
- Dentist
- Los Angeles, CA
National Provider Identifier
1033767579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104250
- Practice address
- 5877 S Vermont Ave
Los Angeles, CA 90044-3741 - Phone
- (323) 759-1523
- NPI assigned
- Aug 28, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 104250 | CA | Primary |
Addresses
Primary practice location
5877 S Vermont Ave
Los Angeles, CA 90044-3741
Mailing address
96 Chantilly
Irvine, CA 92620-2805
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200208000228 | CA | Order and Referring Only - Dentist | 8628404795 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1033767579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "96 CHANTILLY",
"city": "IRVINE",
"state": "CA",
"postal_code": "926202805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5877 S VERMONT AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900443741",
"telephone_number": "323-759-1523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ANNIE",
"middle_name": "YOUNGEUN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-28",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; 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.