NPIMap

Organization Active NPI

Chan M. Park, D.D.S., M.D., PC and Benjamin R. Shimel, D.D.S., PC a PA

Doing business as Sycamore Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • San Ramon, CA
National Provider Identifier
1124660014
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
CHAN M. PARK, D.D.S., M.D., PC AND BENJAMIN R. SHIMEL, D.D.S., PC A PA
Doing business as
Sycamore Oral & Maxillofacial Surgery
Practice address
111 Deerwood Rd Ste 130
San Ramon, CA 94583-2194
Phone
(925) 217-4884
Fax
(925) 217-4895
NPI assigned
Oct 11, 2019
Last updated
Oct 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Authorized official

Name
Chan M Park, MD, DDSNPI 1871617027
Title
Partner
Phone
(925) 217-4884

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

111 Deerwood Rd Ste 130
San Ramon, CA 94583-2194

Mailing address

111 Deerwood Rd Ste 130
San Ramon, CA 94583-2194
Phone (925) 217-4884

Other names 1

  • Sycamore Oral & Maxillofacial Surgery Doing business as

National Provider Directory

National Provider Directory

Locations

111 Deerwood Rd
Ste 130
San Ramon, CA 94583
Phone (925) 217-4884

Practitioners & affiliated clinicians

Practitioners 2

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": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1124660014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DEERWOOD RD STE 130",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945832194",
            "telephone_number": "925-217-4884",
            "fax_number": "925-217-4895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DEERWOOD RD STE 130",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945832194",
            "telephone_number": "925-217-4884",
            "fax_number": "925-217-4895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAN M. PARK, D.D.S., M.D., PC AND BENJAMIN R. SHIMEL, D.D.S., PC A PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "CHAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "925-217-4884",
        "authorized_official_credential": "MD, DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sycamore Oral & Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Ramon, CA

Sources for this page

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

Verify at the official NPI Registry.