Seong Hwan Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0160134190 Issued in VT

Practice address

77 S Main St
Waterbury, VT 05676-1555

Phone

(802) 244-6366

NPI assigned

May 31, 2023

Last updated

May 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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 VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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

• Northeast Washington County Community Health, Inc.

  dba The Health Center

  • Federally Qualified Health Center (FQHC)
  • Plainfield, VT
  • NPI 1699755348
  Medicare reassignment NPD
• Northeast Washington County Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Cabot, VT
  • NPI 1902008485
  NPD

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1801589346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3512 CHILDRESS TER",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208662016",
            "telephone_number": "301-787-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 S MAIN ST",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761555",
            "telephone_number": "802-244-6366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SEONG HWAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VT",
            "license": "0160134190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert W Murray, MD
• Northern Lights Family Chiropractic PLLC
• Travis A. Nutting, MSCMH
• Ana O'Neill, M.S.
• Viann Oden, MA, LMFT
• Victoria L. Pawulak, ADN, RN
• Jonathan B. Phyfe, BA
• Katherine Powell
• Provencher Physical Therapy, Inc. (Family Physcial Therapy)
• Kathy C Provencher

• Dentist in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Dentist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; 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.