Michael H Park, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

106120 Issued in CA

Practice address

702 Via del Monte
Palos Verdes Estates, CA 90274-1612

Phone

(224) 595-9132

NPI assigned

Aug 18, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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.

• M Park Dental Inc

  • Pediatric Dentistry
  • Torrance, CA
  • NPI 1508572439
  NPD Authorized official

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

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1194270231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 VIA DEL MONTE",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902741612",
            "telephone_number": "224-595-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 VIA DEL MONTE",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902741612",
            "telephone_number": "224-595-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MICHAEL",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-18",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02672200",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "106120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Palos Verdes Estates, CA
• Providers in Palos Verdes Estates, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; 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.