Ryan Park, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

17982 Issued in MD

Practice address

411 Hurley Avenue
Rockville, MD 20850

Phone

(224) 500-1814

NPI assigned

Jun 20, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1316477524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13975 CONNECTICUT AVE STE 208",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209062921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 HURLEY AVENUE",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "20850",
            "telephone_number": "224-500-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-20",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "IL",
            "license": "019.031142",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "17982",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.031142",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "019.031142",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE - OFMS",
            "identifier": "17982",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Alane Park, LCSW-C, LICSW
• John Ho Park, D.C.
• Ju-Un Julian Park, MD
• Min Park, OTR/L
• Paul Monsoo Park, M.D.
• Seungsun Ellen Park, AUD
• Soh Park
• Stephanie Grace Park, PH.D.
• Stephen Joseph Park, M.D.
• Sunhee Park

• Oral and Maxillofacial Surgery (Dentist) in Rockville, MD
• Providers in Rockville, MD by specialty
• Oral and Maxillofacial Surgery (Dentist) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; 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.