Jun Sup Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

107810 Issued in CA

Practice address

8612 Firestone Blvd
Downey, CA 90241-5243

Phone

(562) 382-1528

NPI assigned

Apr 27, 2017

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Howell Dental Care Center PLLC

  • General Practice Dentistry
  • Howell, MI
  • NPI 1619510401
  NPD (past)
• Howell Dental Center

  • Exclusive Provider Organization
  • Howell, MI
  • NPI 1952588741
  NPD (past)
• Kuras Dental Health Associates

  • General Practice Dentistry
  • Monroe, MI
  • NPI 1043350762
  NPD (past)
• Northside Dental PLLC

  • General Practice Dentistry
  • Monroe, MI
  • NPI 1659844413
  NPD (past)

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1669907663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8612 FIRESTONE BLVD",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902415243",
            "telephone_number": "562-382-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8612 FIRESTONE BLVD",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902415243",
            "telephone_number": "562-382-1528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JUN SUP",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-27",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901022211",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Anesthesia a Nursing Corporation
• Janice Park-Kim, DDS
• Anna Nayoung Park
• Esther Park
• Jonah Park
• Jung Mok Park, M.D.
• Kevin S. Park, M.D.
• Michelle Ahleum Park
• Michelle Anna Park, PHARM.D.
• Nikki Hyunhee Park, M.D.

• Dentist in Downey, CA
• Providers in Downey, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.