NPIMap

Organization Active NPI

Kim & Park a Dental Corporation

Doing business as moreno dental care

  • General Practice Dentistry
  • Moreno Valley, CA
National Provider Identifier
1699969998
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
50087 Issued in CA
Legal business name
KIM & PARK A DENTAL CORPORATION
Doing business as
moreno dental care
Practice address
23750 Alessandro Blvd
Suite O-102
Moreno Valley, CA 92553-8811
Phone
(951) 656-0088
Fax
(951) 656-0034
NPI assigned
Aug 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

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

Authorized official

Name
Dr. Charles C Park, DDS
Title
President
Phone
(951) 656-0088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 50087 CA Primary

Addresses

Primary practice location

23750 Alessandro Blvd
Suite O-102
Moreno Valley, CA 92553-8811

Mailing address

23750 Alessandro Blvd
Suite O-102
Moreno Valley, CA 92553-8811
Phone (951) 656-0088

Other identifiers 1

IdentifierTypeStateIssuer
G89861-01OtherCADENTI-CAL

Other names 1

  • moreno dental care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kimpark a Dental Corporation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23750 Alessandro Blvd
Ste O102
Moreno Valley, CA 92553
Phone (951) 656-0088

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1699969998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23750 ALESSANDRO BLVD",
            "address_2": "SUITE O-102",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925538811",
            "telephone_number": "951-656-0088",
            "fax_number": "951-656-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23750 ALESSANDRO BLVD",
            "address_2": "SUITE O-102",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925538811",
            "telephone_number": "951-656-0088",
            "fax_number": "951-656-0034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM & PARK A DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-656-0088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "G89861-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "moreno dental care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.