Jin Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

54066 Issued in CA

Practice address

17526 Chatsworth St
Granada Hills, CA 91344-5719

Phone

(818) 832-2828

Fax

(818) 832-2827

NPI assigned

Mar 17, 2011

Sex

Female

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300320000000",
    "number": "1851690861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17526 CHATSWORTH ST",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913445719",
            "telephone_number": "818-832-2828",
            "fax_number": "818-832-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17526 CHATSWORTH ST",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913445719",
            "telephone_number": "818-832-2828",
            "fax_number": "818-832-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-17",
        "last_updated": "2011-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Luis Pandeli
• Lusine Panikyan
• Mariam M Papazyan, PHARMD
• Violeta Papazyan, FNP
• Dong Keun Park, D.D.S
• Richard Park, M.D.
• Farbod Parvinjah, D.M.D
• Neeraj M Patel, M.D.
• Path T0 Mindful Balanced Mental Wellness, Inc
• Path2 Recovery Center LLC

• General Practice Dentistry in Granada Hills, CA
• Providers in Granada Hills, 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 Mar 17, 2011; 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.