Active NPI
Sung Park, DMD
- Dentist
- Woodside, NY
National Provider Identifier
1538427786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 055824
- Practice address
- 6804 43Rd Ave FL 1
Woodside, NY 11377-5153 - Phone
- (347) 459-5235
- NPI assigned
- Apr 25, 2012
- Last updated
- May 15, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 055824 | NY | Primary |
Addresses
Primary practice location
6804 43Rd Ave FL 1
Woodside, NY 11377-5153
Mailing address
68-04 43Rd Ave 1FL
Woodside, NY 11377
Phone (347) 459-5235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160106002237 | NY | Order and Referring Only - Dentist | 2062714165 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055824 | NY | MD | Clinical Pharmacology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337040000000",
"number": "1538427786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68-04 43RD AVE 1FL",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "11377",
"telephone_number": "347-459-5235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6804 43RD AVE FL 1",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113775153",
"telephone_number": "347-459-5235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SUNG",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-25",
"last_updated": "2012-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "055824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; 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.