NPIMap

Organization Active NPI

Park Dental Associates P.C.

  • Prosthodontics
  • Philadelphia, PA
National Provider Identifier
1164709093
Registry record updated Nov 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
DS035815 Issued in PA
Legal business name
PARK DENTAL ASSOCIATES P.C.
Practice address
1512 Sansom St
#300
Philadelphia, PA 19102-2809
Phone
(215) 564-0717
Fax
(215) 564-5450
NPI assigned
Nov 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2011

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

Authorized official

Name
Dr. Yeun-June Park, DMD, MSDNPI 1457482812
Title
President/Prosthodontist
Phone
(215) 564-0717

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
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X DS035815 PA Primary

Addresses

Primary practice location

1512 Sansom St
#300
Philadelphia, PA 19102-2809

Mailing address

1512 Sansom St
#300
Philadelphia, PA 19102-2809
Phone (215) 564-0717

National Provider Directory

National Provider Directory

Locations

1512 Sansom St
Ste 300
Philadelphia, PA 19102
Phone (215) 564-0717

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320537600000",
    "number": "1164709093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 SANSOM ST",
            "address_2": "#300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022809",
            "telephone_number": "215-564-0717",
            "fax_number": "215-564-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 SANSOM ST",
            "address_2": "#300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022809",
            "telephone_number": "215-564-0717",
            "fax_number": "215-564-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK DENTAL ASSOCIATES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-06",
        "last_updated": "2011-11-06",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "YEUN-JUNE",
        "authorized_official_title_or_position": "PRESIDENT/PROSTHODONTIST",
        "authorized_official_telephone_number": "215-564-0717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "PA",
            "license": "DS035815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2011; 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.