Derek Park, M.D., D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

59748 Issued in CA

Practice address

581 Foster City Blvd
Foster City, CA 94404-1695

Phone

(650) 286-9999

NPI assigned

Apr 1, 2013

Last updated

Jan 3, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• UCSF Oral & Maxillofacial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • San Francisco, CA
  • NPI 1679652598

  Oral and Maxillofacial Surgery

  Medicare reassignment NPD
• University of California SFGH Medical Group

  dba UCSF SFGH Medical Group Dept of Otolaryngology

  • Otolaryngology Physician
  • San Francisco, CA
  • NPI 1154396208
  Medicare reassignment NPD
• University of California SFGH Medical Group

  dba UCSF SFGH Medical Group Division of Vascular Surgery

  • Vascular Surgery Physician
  • San Francisco, CA
  • NPI 1033913959
  NPD
• Aaron Reeves, Reeves Specialty Dental Corporation

  • Pediatric Dentistry
  • Elk Grove, CA
  • NPI 1215528112
  NPD (past)
• Aaron Reeves, Reeves Specialty Dental Corporation

  • Pediatric Dentistry
  • Folsom, CA
  • NPI 1922699826
  NPD (past)
• Maung Patel Oms Partnership

  dba Santa Clara Oral Surgery & Dental Implants

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Santa Clara, CA
  • NPI 1124799572
  NPD (past)
• Polly Chan DDS Inc

  • Dentist
  • Foster City, CA
  • NPI 1508931247
  NPD (past)
• UCSF Oral Surgery CL. #20-3

  • Oral and Maxillofacial Surgery (Dentist)
  • San Francisco, CA
  • NPI 1912375510
  NPD (past)

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1770826406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "581 FOSTER CITY BLVD",
            "city": "FOSTER CITY",
            "state": "CA",
            "postal_code": "944041695",
            "telephone_number": "650-286-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "581 FOSTER CITY BLVD",
            "city": "FOSTER CITY",
            "state": "CA",
            "postal_code": "944041695",
            "telephone_number": "650-286-9999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2118 McKee Rd",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951161427",
            "country_code": "US",
            "telephone_number": "408-272-2322",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Scott Blvd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Santa Clara",
            "state": "CA",
            "postal_code": "950504555",
            "country_code": "US",
            "telephone_number": "408-248-9597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "M.D., D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-01",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "59748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurie Novinsky, DDS
• Melanie E Odeleye, MD
• Robert Osheroff, DPM
• Renee Ostertag, D.P.T.
• Sergio Rodrigo Palza
• Nirali Patel, L.AC
• Tunan Peng, L.AC
• Martin D Phandl
• Jason Pierce
• Polly Chan DDS Inc

• Oral and Maxillofacial Surgery (Dentist) in Foster City, CA
• Providers in Foster City, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.