Bumsoo Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

109034 Issued in CA

Practice address

1115 S Sanderson Ave
Hemet, CA 92545-9047

Phone

(951) 404-5307

Fax

(951) 905-1760

NPI assigned

Aug 11, 2023

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

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

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.

• Hart and Lee Dental Corporation

  • Dentist
  • Hemet, CA
  • NPI 1699264473
  NPD (past)

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

{
    "created_epoch": "1691712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1386327690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 S SANDERSON AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925459047",
            "telephone_number": "951-404-5307",
            "fax_number": "951-905-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 S SANDERSON AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925459047",
            "telephone_number": "951-404-5307",
            "fax_number": "951-905-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "BUMSOO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-11",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandeep Pandove, MD
• Milind P Panse, M.D.
• Savannah Pantoja
• Mary Helen Panushka, D.P.T.
• Nancy Lee Paolercio, DPM
• Monique Parker Jackson
• Chanel Parker
• Linda Joyce Parker, BA SOCIAL WORK
• Rachel Anne Parker, PA-C
• Willie Parker

• Dentist in Hemet, CA
• Providers in Hemet, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.