S Park DDS Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

S PARK DDS INC

Practice address

6163 Mack Rd
Sacramento, CA 95823-4654

Phone

(888) 585-3368

Fax

(661) 471-2121

NPI assigned

Dec 4, 2020

Organization subpart

Yes

Parent organization

S PARK DDS INCAs reported in NPPES

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

Authorized official

Name

David S Park

Title

Dentist/Owner

Phone

(310) 403-1117

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Smile Dental of South Sacramento Doing business as

Tax ID family

S Park DDS Inc2 organizations share this tax ID, including this one

Part of

S Park DDS Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• S Park DDS Inc

  • General Practice Dentistry
  • Elk Grove, CA
  • NPI 1558763771
  NPD tax ID

Locations

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1104422245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6163 MACK RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958234654",
            "telephone_number": "888-585-3368",
            "fax_number": "661-471-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6163 MACK RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958234654",
            "telephone_number": "888-585-3368",
            "fax_number": "661-471-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S PARK DDS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "S PARK DDS INC",
        "enumeration_date": "2020-12-04",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "310-403-1117"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53724",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Dental of South Sacramento",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erin Nicole Rysanek, MS, LAT, ATC
• Janice Ryu, M.D.
• Dragily Ryucer
• S Jang DDS Incorporated
• S Jang DDS Incorporated
• S. Jang DDS Incorporated
• S.H.C.C. , Inc.
• S.L.H.C.C. Inc.
• S.Y. Jang DDS Corporatiom
• S.Y.Y Jang DDS Corp

• General Practice Dentistry in Sacramento, CA
• Providers in Sacramento, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.