Sam S Park, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DDS101611 Issued in CA

Practice address

1222 Magnolia Ave Ste 101
Corona, CA 92881-2075

Phone

(909) 256-0456

NPI assigned

Aug 7, 2017

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Sam Park DMD PLLC

  • General Practice Dentistry
  • Las Vegas, NV
  • NPI 1376479378
  NPD Authorized official
• Centro Medico and Dental Inc

  • Dental Clinic/Center
  • Los Angeles, CA
  • NPI 1568256329
  NPD (past)

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

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1831614213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 CRESTRIDGE RD APT 210",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902753580",
            "telephone_number": "310-344-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 MAGNOLIA AVE STE 101",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928812075",
            "telephone_number": "909-256-0456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "514 E Washington Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900153723",
            "country_code": "US",
            "telephone_number": "213-749-3934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "SAM",
        "middle_name": "S",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS101611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevyn Parish
• Bin Ho Park, D.D.S.
• Colton Park
• Helena Songhee Park, NP
• Michele Park
• Yuna Park, MD
• Lydia Park,
• Parker & Bell a Chiropractic Corp
• Jenifer Ayn Parker Lopez, SLP
• Andrew Parker

• Dentist in Corona, CA
• Providers in Corona, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.