Individual provider Active NPI

Sanghoon Park, DDS

  • General Practice Dentistry
  • Garden Grove, CA
National Provider Identifier
1235277963
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
54608 Issued in CA
Practice address
10055 Garden Grove Blvd
Garden Grove, CA 92844-1600
Phone
(714) 638-4042
Fax
(714) 638-2141
NPI assigned
Feb 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 54608 CA Primary

Addresses

Primary practice location

10055 Garden Grove Blvd
Garden Grove, CA 92844-1600

Mailing address

10055 Garden Grove Blvd
Garden Grove, CA 92844-1600
Phone (714) 638-4042

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
54608CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1235277963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10055 GARDEN GROVE BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441600",
            "telephone_number": "714-638-4042",
            "fax_number": "714-638-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10055 GARDEN GROVE BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441600",
            "telephone_number": "714-638-4042",
            "fax_number": "714-638-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SANGHOON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; 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.