Kyung Wook Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

051203 Issued in NY

Practice address

44031 Pipeline PLZ
Suite 215
Ashburn, VA 20147-5887

Phone

(646) 489-8909

NPI assigned

Jan 29, 2007

Last updated

Jun 20, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308528000000",
    "number": "1669518676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9659 EATON WOODS PL",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220792338",
            "telephone_number": "646-489-8909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44031 PIPELINE PLZ",
            "address_2": "SUITE 215",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475887",
            "telephone_number": "646-489-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KYUNG",
        "middle_name": "WOOK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2011-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051203",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401411803",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Veloso Panzer, MD
• Nikolaos Papageorgiou, DDS
• Paradigm Shift LLC
• Daniel Paris, PSY.D.
• Carolyn Park
• Roy Edward Park, OD
• Stephanie Park, PHARM D
• Jenna Parker, LMSW
• Chad Parsons, D.C.
• Ashley Passarelli, CCC-SLP

• General Practice Dentistry in Ashburn, VA
• Providers in Ashburn, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; 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.