Active NPI
Robert Park, D.D.S.
- Dentist
- Los Angeles, CA
National Provider Identifier
1578749610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 33351
- Practice address
- 4220 W 3Rd St
Ste 202
Los Angeles, CA 90020-3450 - Phone
- (213) 382-3215
- NPI assigned
- Jan 19, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 33351 | CA | Primary |
Addresses
Primary practice location
4220 W 3Rd St
Ste 202
Los Angeles, CA 90020-3450
Mailing address
4220 W 3Rd St
Ste 202
Los Angeles, CA 90020-3450
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 |
|---|---|---|---|
| 33351 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robert Taehong Park DDS, Inc. | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Los Angeles, CA
- NPI 1164542635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200700800000",
"number": "1578749610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4220 W 3RD ST",
"address_2": "STE 202",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900203450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4220 W 3RD ST",
"address_2": "STE 202",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900203450",
"telephone_number": "213-382-3215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ROBERT",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-19",
"last_updated": "2008-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "33351",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.