NPIMap

Organization Active NPI

Soo T Park DDS Inc

Doing business as Park Dental Group

  • Dentist
  • Lancaster, CA
National Provider Identifier
1679538037
Registry record updated Oct 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
33967 Issued in CA
Legal business name
SOO T PARK DDS INC
Doing business as
Park Dental Group
Practice address
44841 N 10TH St W
Lancaster, CA 93534
Phone
(661) 948-1655
Fax
(661) 940-9636
NPI assigned
Apr 19, 2006
Last updated
Oct 9, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2013

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

Authorized official

Name
Mr. Soo Tae Park, DDSNPI 1124084728
Title
Owner President
Phone
(661) 948-1655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 33967 CA Primary
Dentist 122300000X 22315 CA
Dentist 122300000X 16496 CA

Addresses

Primary practice location

44841 N 10TH St W
Lancaster, CA 93534

Mailing address

44841 N 10TH St W
Lancaster, CA 93534
Phone (661) 948-1655

Other identifiers 1

IdentifierTypeStateIssuer
G9225701MedicaidCA

Other names 1

  • Park Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

44841 10th St W
Lancaster, CA 93534
Phone (661) 948-1655

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381276800000",
    "number": "1679538037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44841 N 10TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "661-948-1655",
            "fax_number": "661-940-9636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44841 N 10TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "661-948-1655",
            "fax_number": "661-940-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOO T PARK DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2013-10-09",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "SOO",
        "authorized_official_middle_name": "TAE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "661-948-1655",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "33967",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "22315",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "16496",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9225701",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; 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.