Tae-Hoon Park, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11619 Issued in TN

Practice address

1300 N Ellington Pkwy
Lewisburg, TN 37091-2218

Phone

(931) 359-2825

NPI assigned

Aug 22, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Park Dental Group Inc

  • Dental Clinic/Center
  • Lake Forest, CA
  • NPI 1952877854
  NPD Authorized official
• Discovery Expeditions

  • General Practice Dentistry
  • Lewisburg, TN
  • NPI 1174386627
  NPD

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733529600000",
    "number": "1720271752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N ELLINGTON PKWY",
            "city": "LEWISBURG",
            "state": "TN",
            "postal_code": "370912218",
            "telephone_number": "931-359-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N ELLINGTON PKWY",
            "city": "LEWISBURG",
            "state": "TN",
            "postal_code": "370912218",
            "telephone_number": "931-359-2825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "TAE-HOON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2024-12-07",
        "certification_date": "2024-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56079",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "123971",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NHC-Op LP
• Northland Hearing Center, Inc.
• Northside Medical Professionals, P.C.
• Teah Obeidalla
• Rhiannon Parent
• Bradly Parmely, PTA
• Parsons Pharmacy Inc
• PCL Express Walk-in Clinic, LLC
• Kerry Kay Peete, FNP
• Charlton A Peter, DPM

• General Practice Dentistry in Lewisburg, TN
• Providers in Lewisburg, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2024; 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.