Active NPI
Chanseop Park, DDS, MSD
- Prosthodontics
- Houston, TX
National Provider Identifier
1295975662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- DE60013033
- Practice address
- 6516 M D Anderson Blvd RM 422
Houston, TX 77030-3402 - Phone
- (713) 500-4267
- Fax
- (713) 500-4353
- NPI assigned
- Feb 25, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | DE60013033 | WA | Primary |
Addresses
Primary practice location
6516 M D Anderson Blvd RM 422
Houston, TX 77030-3402
Mailing address
6516 M D Anderson Blvd RM 422
Houston, TX 77030-3402
Phone (713) 500-4267
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160413002104 | WA | Order and Referring Only - Dentist | 0749588465 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60013033 | WA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235520000000",
"number": "1295975662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6516 M D ANDERSON BLVD RM 422",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770303402",
"telephone_number": "713-500-4267",
"fax_number": "713-500-4353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6516 M D ANDERSON BLVD RM 422",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770303402",
"telephone_number": "713-500-4267",
"fax_number": "713-500-4353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "CHANSEOP",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-25",
"last_updated": "2009-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "WA",
"license": "DE60013033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; 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.