Soon Jun Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

103838 Issued in CA

Practice address

26000 W Lugonia Ave Apt 3418
Redlands, CA 92374-5110

Phone

(909) 589-4466

NPI assigned

Jul 7, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1215615489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26000 W LUGONIA AVE APT 3418",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923745110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26000 W LUGONIA AVE APT 3418",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923745110",
            "telephone_number": "909-589-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SOON JUN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "103838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Park, DDS
• Jonathan Park
• Kenneth J Park, DO
• Moses I Park, M.D.
• Shelley J Park, N.P.
• Darby Alice Parker, OTRL, CHT
• Telisa Sharesse Parker
• Heather Kathleen Parlett, PA-C
• Laura Stella Parra Puerto, LMFT
• Larrie Parreno, DPT

• General Practice Dentistry in Redlands, CA
• Providers in Redlands, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.