Myung Kee Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

101614 Issued in CA

Practice address

473 E Alessandro Blvd # a
Riverside, CA 92508-6021

Phone

(951) 789-6886

Fax

(951) 780-1998

NPI assigned

Aug 21, 2017

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 CA

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Myung Kee Park DDS Inc

  • Dental Clinic/Center
  • Moreno Valley, CA
  • NPI 1255100020
  NPD Authorized official
• Park and Park Dental Group Partnership

  • Dental Clinic/Center
  • Riverside, CA
  • NPI 1215535182
  NPD Authorized official

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1154847234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7360 AYERS ROCK RD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925086044",
            "telephone_number": "909-524-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 E ALESSANDRO BLVD # A",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925086021",
            "telephone_number": "951-789-6886",
            "fax_number": "951-780-1998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MYUNG KEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-21",
        "last_updated": "2023-03-08",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jin Hwi Park, DDS
• Jong Min Park, PHARMD.
• Julie Son Park
• Kyungsin Park, DDS
• Melissa Park, RN
• Nathaniel Park, MD
• Sherie L Park, LMFT
• Vanessa Ceballos Park, O.D.
• Wonsok Park, D.C.
• Woojung Park

• Dentist in Riverside, CA
• Providers in Riverside, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; 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.