Individual provider Active NPI

Angela Hyoeun Park, DMD

  • Dentist
  • Long Beach, CA
National Provider Identifier
1649167123
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
111663 Issued in CA
Practice address
6437 E Pacific Coast Hwy Unit a-6
Long Beach, CA 90803-4201
Phone
(562) 280-5200
NPI assigned
Jun 18, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 111663 CA Primary

Addresses

Primary practice location

6437 E Pacific Coast Hwy Unit a-6
Long Beach, CA 90803-4201

Mailing address

1313 Glenthorpe Dr
Walnut, CA 91789-3859
Phone (909) 938-2152

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20250924002699 CA Order and Referring Only - DentistPractitioner - Dentist 1951806686

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Victoria Nguyen Dental Corporation Dentist PastSince Jun 23, 2025 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.

NPI Registry JSON

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

{
    "created_epoch": "1750204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1649167123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 GLENTHORPE DR",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917893859",
            "telephone_number": "909-938-2152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6437 E PACIFIC COAST HWY UNIT A-6",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908034201",
            "telephone_number": "562-280-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ANGELA",
        "middle_name": "HYOEUN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-18",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "111663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.