Susan Mekyung Park, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D8866 Issued in OR

Practice address

363 SE 4TH Ave
Hillsboro, OR 97123-4281

Phone

(503) 640-1313

NPI assigned

May 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

Enrolled in CA

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

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: spark@direct.westerndental.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Melvin L. Matsuda DDS PC

  • Periodontics
  • Hillsboro, OR
  • NPI 1043428436
  NPD (past)
• Michael Matsuda DDS, PC

  dba Hillsboro Implants & Periodontics

  • Periodontics
  • Hillsboro, OR
  • NPI 1275120925
  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306052683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 NW 9TH AVE APT 803",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092896",
            "telephone_number": "503-320-7288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 SE 4TH AVE",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971234281",
            "telephone_number": "503-640-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUSAN",
        "middle_name": "MEKYUNG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D8866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alex Sungwook Park, PHARM.D.
• Edward Chul Park, D.D.S.
• Kyong Zu Park, PMHNP
• Lauren Mi Ae Park
• Paul Park, MD
• Jordyn Paige Parker-Mayforth
• Kate Parker-Shames, MS
• Colleen M. Parker, PH.D.
• Lyndsay Katherine Parker
• Marissa Parker

• Periodontics in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Periodontics in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.