Active NPI
Sohyun Park, DDS, MDS
- Periodontics
- San Francisco, CA
National Provider Identifier
1356624175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DDS102257
- Practice address
- 450 Sutter St RM 2400
San Francisco, CA 94108-4203 - Phone
- (415) 989-0550
- NPI assigned
- Sep 28, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DS040069 | PA | |
| Periodontics | 1223P0300X | DDS102257 | CA | Primary |
Addresses
Primary practice location
450 Sutter St RM 2400
San Francisco, CA 94108-4203
Mailing address
450 Sutter St RM 2400
San Francisco, CA 94108-4203
Phone (415) 989-0550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 2, 2025 through Jul 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102257 | CA | MD | Marriage & Family Therapist |
| DDS102257 | CA | MD | Periodontist |
| DS040069 | PA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543104000000",
"number": "1356624175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 SUTTER ST RM 2400",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941084203",
"telephone_number": "415-989-0550",
"fax_number": "415-989-0554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 SUTTER ST RM 2400",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941084203",
"telephone_number": "415-989-0550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SOHYUN",
"credential": "DDS, MDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-28",
"last_updated": "2018-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS040069",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "DDS102257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2018; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.