Sang Park, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DS037330 Issued in PA

Practice address

2050 W Chester Pike
Suite 4
Havertown, PA 19083-2744

Phone

(610) 789-0158

Fax

(610) 789-9238

NPI assigned

Sep 3, 2014

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 PA

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

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

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409875200000",
    "number": "1588064026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 W CHESTER PIKE",
            "address_2": "SUITE 4",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190832744",
            "telephone_number": "610-789-0158",
            "fax_number": "610-789-9238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 W CHESTER PIKE",
            "address_2": "SUITE 4",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190832744",
            "telephone_number": "610-789-0158",
            "fax_number": "610-789-9238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SANG",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-03",
        "last_updated": "2014-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS037330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Krupa S Parikh, DDS
• Kyong Bin Park, M.D.
• Timothy J Parsons
• Partners in Care at Home LLC
• Nikita Sunil Patel, PT, DPT
• Michael Andrew Patton, R.PH
• Katie Paugh, M.S. OTR/L

• All providers in Havertown, PA
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; 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.