NPIMap

Organization Active NPI

D Park MPH DDS Dental Corporation

Doing business as Pacific Dental Group

  • General Practice Dentistry
  • Stockton, CA
National Provider Identifier
1124572284
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
D PARK MPH DDS DENTAL CORPORATION
Doing business as
Pacific Dental Group
Practice address
7743 West LN Ste C5
Stockton, CA 95210-3381
Phone
(209) 474-1101
NPI assigned
Aug 6, 2016
Last updated
Jan 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
D PARK MPH DDS DENTAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Mr. David Sangho Park, DDS, MPHNPI 1942410501
Title
Ceo, Cfo
Phone
(310) 403-1117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

7743 West LN Ste C5
Stockton, CA 95210-3381

Mailing address

7743 West LN Ste C5
Stockton, CA 95210-3381
Phone (209) 474-1101

Other names 1

  • Pacific Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
D Park MPH DDS Dental Corporation2 organizations share this tax ID, including this one
Part of
D Park MPH DDS Dental Corporation

Other organizations with this tax ID 1

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

Locations

7743 West Ln
Ste C5
Stockton, CA 95210
Phone (209) 474-1101

2616 Pavilion Pkwy
Tracy, CA 95304
Phone (209) 839-8333

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1124572284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7743 WEST LN STE C5",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103381",
            "telephone_number": "209-474-1101",
            "fax_number": "209-474-9734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7743 WEST LN STE C5",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103381",
            "telephone_number": "209-474-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D PARK MPH DDS DENTAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "D PARK MPH DDS DENTAL CORPORATION",
        "enumeration_date": "2016-08-06",
        "last_updated": "2022-01-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "SANGHO",
        "authorized_official_title_or_position": "CEO, CFO",
        "authorized_official_telephone_number": "310-403-1117",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS, MPH"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.