Phillip S.H Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42593 Issued in CA

Practice address

742 E Colorado Blvd
Pasadena, CA 91101-2105

Phone

(626) 405-0707

Fax

(626) 405-8876

NPI assigned

Jul 21, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Phillip S.H. Park DDS.,Inc.

  • General Practice Dentistry
  • Pasadena, CA
  • NPI 1750304192
  NPD (past) Authorized official

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367539200000",
    "number": "1811917636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 E COLORADO BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012105",
            "telephone_number": "626-405-0707",
            "fax_number": "626-795-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 E COLORADO BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012105",
            "telephone_number": "626-405-0707",
            "fax_number": "626-405-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "PHILLIP",
        "middle_name": "S.H",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2013-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE GOVERMENT HEALTHY F",
            "identifier": "B42593-01",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G91415-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Min Park, NP
• Kara Faith Heeyoung Park, LMFT
• Kristoffer Park
• Kwang Hee Park, L.AC
• Margaret Park, OTR/L
• Sue Jean Park, DDS
• Susan S. Park, PH.D.
• Catharine Parker
• Jill Parker, D.D.S.
• Kimm Parker, LCSW

• General Practice Dentistry in Pasadena, CA
• Providers in Pasadena, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2013; 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.