Alice Park

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

112159 Issued in CA

Practice address

2310 Craven St
San Diego, CA 92136-4020

Phone

(619) 556-8240

NPI assigned

Jun 23, 2023

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1558047712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12198 FERNCREST PL",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921284349",
            "telephone_number": "858-442-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 CRAVEN ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921364020",
            "telephone_number": "619-556-8240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ALICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "112159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Medical Supplies, Inc
• Park Optometry, Inc
• Park Row Podiatry Inc.
• Aaron Park
• Aaron Park
• Andrew C Park, DMD
• Angela Solji Park, DO
• Annette Narae Park
• Autumn Park
• Boyle Park, MD

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.