Active NPI
Sang Hyuk Park, D.D.S.
- Dentist
- Merced, CA
National Provider Identifier
1669478871
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Dec 18, 2014.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 47654
- Practice address
- 3040 Park Ave
Ste H
Merced, CA 95348-3405 - Phone
- (209) 722-7789
- Fax
- (209) 722-7811
- NPI assigned
- Jun 22, 2005
- Last updated
- Apr 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 47654 | CA | Primary |
Addresses
Primary practice location
3040 Park Ave
Ste H
Merced, CA 95348-3405
Mailing address
6383 Pine Meadow Cir
Stockton, CA 95219-2543
Phone (415) 867-1603
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47654 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208995200000",
"number": "1669478871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6383 PINE MEADOW CIR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952192543",
"telephone_number": "415-867-1603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3040 PARK AVE",
"address_2": "STE H",
"city": "MERCED",
"state": "CA",
"postal_code": "953483405",
"telephone_number": "209-722-7789",
"fax_number": "209-722-7811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SANG HYUK",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-22",
"last_updated": "2008-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "47654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merced, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.