Chin W. Park

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN23386 Issued in FL

Practice address

10601 San Jose Blvd Ste 117
Jacksonville, FL 32257-6267

Phone

(904) 483-3027

NPI assigned

Jun 1, 2018

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 FL

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

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527811200000",
    "number": "1063904449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10601 SAN JOSE BLVD STE 117",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10601 SAN JOSE BLVD STE 117",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576267",
            "telephone_number": "904-483-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHIN",
        "middle_name": "W.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-01",
        "last_updated": "2018-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN23386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra M Park Burdon, RT
• Park Homecare Management,Inc
• Park Ridge Nursing & Rehab Center LLC
• Holly Hyunjung Park-Nah, DDS
• Charles Sue Park, MD
• Kwang SE Park, M.D.
• Lauren Park
• Lucienne Park, DMD
• Michelle Park
• Minnsun Koh Park, M.D.

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; 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.