Active NPI
Kwang Min Park
- General Practice Dentistry
- Las Vegas, NV
National Provider Identifier
1194194506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7470
- Practice address
- 7171 W Craig Rd Ste 102
Las Vegas, NV 89129-6018 - Phone
- (702) 655-0331
- Fax
- (702) 655-0377
- NPI assigned
- Sep 16, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1856730 | MA | |
| General Practice Dentistry | 1223G0001X | 7470 | NV | Primary |
Addresses
Primary practice location
7171 W Craig Rd Ste 102
Las Vegas, NV 89129-6018
Mailing address
2660 N Buffalo Dr Unit 1322
Las Vegas, NV 89128-4829
Phone (781) 325-5634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1856730 | MA | MD | Dentist |
| 7470 | NV | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KMP Dental PLLC | Current | Accepting new patients | |
| Shahrestani Las Vegas Modern Dentistry, PC | General Practice | Past | Accepting new patients |
| Dental Associates | Dentist | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Las Vegas Modern Dentistry
- General Practice Dentistry
- Las Vegas, NV
- NPI 1588943948
-
- Dentist
- Quincy, MA
- NPI 1275687592
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634083200000",
"number": "1194194506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2660 N BUFFALO DR UNIT 1322",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891284829",
"telephone_number": "781-325-5634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7171 W CRAIG RD STE 102",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891296018",
"telephone_number": "702-655-0331",
"fax_number": "702-655-0377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KWANG MIN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-16",
"last_updated": "2021-10-13",
"certification_date": "2021-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN1856730",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "7470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.