Active NPI
Soyeon Park
- Dentist
- Chino Hills, CA
National Provider Identifier
1093365017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104386
- Practice address
- 3410 Grand Ave
Chino Hills, CA 91709-1473 - Phone
- (909) 364-0027
- NPI assigned
- Sep 12, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 104386 | CA | Primary |
Addresses
Primary practice location
3410 Grand Ave
Chino Hills, CA 91709-1473
Mailing address
6806 Bank Side Dr
Jurupa Valley, CA 91752-2725
Phone (415) 999-4841
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104386 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568246400000",
"number": "1093365017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6806 BANK SIDE DR",
"city": "JURUPA VALLEY",
"state": "CA",
"postal_code": "917522725",
"telephone_number": "415-999-4841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3410 GRAND AVE",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917091473",
"telephone_number": "909-364-0027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SOYEON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-12",
"last_updated": "2019-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.