Sungbum Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16038 Issued in MD

Practice address

6196 Oxon Hill Rd Ste 540
Oxon Hill, MD 20745-3112

Phone

(301) 686-1665

Fax

(301) 686-1779

NPI assigned

Sep 29, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

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

Practice roles

Locations

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

• Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Brandywine, MD
  • NPI 1912927344

  DC

  Medicare reassignment NPD
• Sjpark Dental, PC

  • General Practice Dentistry
  • Fairfax, VA
  • NPI 1245059492
  NPD Authorized official
• Greater Baden Medical Service Incorporated

  • Federally Qualified Health Center (FQHC)
  • Lexington Park, MD
  • NPI 1487469243
  NPD
• Greater Baden Medical Service Incorporated

  • Dental Clinic/Center
  • Brandywine, MD
  • NPI 1720297278
  NPD
• Dr. David M. Vieth, PC

  • General Practice Dentistry
  • District Heights, MD
  • NPI 1962666065
  NPD (past)

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

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1366692147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6196 OXON HILL RD STE 540",
            "city": "OXON HILL",
            "state": "MD",
            "postal_code": "207453112",
            "telephone_number": "301-686-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6196 OXON HILL RD STE 540",
            "city": "OXON HILL",
            "state": "MD",
            "postal_code": "207453112",
            "telephone_number": "301-686-1665",
            "fax_number": "301-686-1779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7450 Albert Rd Fl 1",
            "address_purpose": "LOCATION",
            "city": "Brandywine",
            "state": "MD",
            "postal_code": "206133035",
            "country_code": "US",
            "telephone_number": "301-836-9645",
            "fax_number": "301-579-9034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUNGBUM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-29",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "16038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "415611100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oxon Hill Primary Medicine PC
• Oxon Hill Smiles Youth Dentistry, PC
• Oxon Hill Urology Surgery Center PC
• Michael Oyewole, PHARM.D.
• Vabian Lewitt Paden, M.D.
• Jemah Parker, RN
• Chintan P Patel, MD
• Pathways 2 Success, LLC
• Tanuja Patil
• Ernestine Patterson

• General Practice Dentistry in Oxon Hill, MD
• Providers in Oxon Hill, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; 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.