Active NPI
Andrew C Park, DMD
- Endodontics
- San Diego, CA
National Provider Identifier
1407040116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 59312
- Practice address
- 43000 Midway Ave BLDG 595
San Diego, CA 92140-5692 - Phone
- (619) 524-4005
- NPI assigned
- Sep 5, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Endodontics | 1223E0200X | 59312 | CA | Primary |
Addresses
Primary practice location
43000 Midway Ave BLDG 595
San Diego, CA 92140-5692
Mailing address
43000 Midway Ave BLDG 595
San Diego, CA 92140-5692
Phone (619) 524-4005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59312 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775088000000",
"number": "1407040116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43000 MIDWAY AVE BLDG 595",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921405692",
"telephone_number": "619-524-4005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43000 MIDWAY AVE BLDG 595",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921405692",
"telephone_number": "619-524-4005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ANDREW",
"middle_name": "C",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-05",
"last_updated": "2026-04-02",
"certification_date": "2026-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "59312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.