Sang C Paik DDS

Primary specialty

DentistTaxonomy code 122300000X

License

41861 Issued in CA

Legal business name

SANG C PAIK DDS

Practice address

11201 Sierra Ave
Suite 1F
Fortana, CA 92337

Phone

(909) 355-3299

Fax

(951) 355-3944

NPI assigned

Apr 18, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sang Churl Paik, DDS

Title

Owner Dentist

Phone

(909) 355-3299

Specialties & licenses 1

Addresses

Other names 1

• Sierra Dental Group Other name

Tax ID family

Eagle Glen Dental Group3 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.

• Sang C Paik DDS

  • Dentist
  • Corona, CA
  • NPI 1497979280
  NPD tax ID
• Sang Paik DDS, Inc

  dba San Jacinto Dental Center

  • General Practice Dentistry
  • San Jacinto, CA
  • NPI 1255544052
  NPD tax ID

Locations

Practitioners 2

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.

• Mauricio Dossantos, DDS

  • General Practice Dentistry
  • Yucaipa, CA
  • NPI 1104176817
  NPD (past)
• Phil Jae Ra, D.D.S.

  • Dentist
  • Fontana, CA
  • NPI 1700901527
  NPD (past)

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740406784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 SIERRA AVE",
            "address_2": "SUITE 1F",
            "city": "FORTANA",
            "state": "CA",
            "postal_code": "92337",
            "telephone_number": "909-355-3299",
            "fax_number": "951-355-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 SIERRA AVE",
            "address_2": "SUITE 1F",
            "city": "FORTANA",
            "state": "CA",
            "postal_code": "92337",
            "telephone_number": "909-355-3299",
            "fax_number": "951-355-3944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANG C PAIK DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PAIK",
        "authorized_official_first_name": "SANG",
        "authorized_official_middle_name": "CHURL",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "909-355-3299",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Dental Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.