Active NPI
Ethan Park DMD Inc
- General Practice Dentistry
- Temple City, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- ETHAN PARK DMD INC
- Practice address
- 5728 Rosemead Blvd Suite 220
Temple City, CA 91780-1814 - Phone
- (626) 500-4340
- Fax
- (626) 544-5335
- NPI assigned
- May 12, 2021
- Last updated
- Jul 13, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ethan SB Park, DDS
- Title
- Owner Dentist
- Phone
- (213) 220-4856
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | |||
| General Practice Dentistry | 1223G0001X | Primary |
Addresses
Primary practice location
5728 Rosemead Blvd Suite 220
Temple City, CA 91780-1814
Mailing address
5728 Rosemead Blvd Unit 220
Temple City, CA 91780-1814
Phone (626) 544-5335
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100873 | Other | CA | DENTIST |
National Provider Directory
National Provider DirectoryLocations
5728 Rosemead Blvd
Unit 220
Temple City, CA 91780
Phone (626) 500-4340
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620777600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1689206400000",
"number": "1275117491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5728 ROSEMEAD BLVD UNIT 220",
"city": "TEMPLE CITY",
"state": "CA",
"postal_code": "917801814",
"telephone_number": "626-544-5335",
"fax_number": "626-544-5335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5728 ROSEMEAD BLVD SUITE 220",
"city": "TEMPLE CITY",
"state": "CA",
"postal_code": "917801814",
"telephone_number": "626-500-4340",
"fax_number": "626-544-5335"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ETHAN PARK DMD INC",
"organizational_subpart": "NO",
"enumeration_date": "2021-05-12",
"last_updated": "2023-07-13",
"certification_date": "2023-07-13",
"status": "A",
"authorized_official_last_name": "PARK",
"authorized_official_first_name": "ETHAN",
"authorized_official_middle_name": "SB",
"authorized_official_title_or_position": "OWNER DENTIST",
"authorized_official_telephone_number": "213-220-4856",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTIST",
"identifier": "100873",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Temple City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.