Kideog Park

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

102006 Issued in CA

Practice address

9618 Garden Grove Blvd Ste 208
Garden Grove, CA 92844-1566

Phone

(714) 537-9380

Fax

(714) 537-2593

NPI assigned

Jul 7, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Sang Lee & Deuk Oh DDS Inc

  • Dentist
  • Garden Grove, CA
  • NPI 1922485416
  NPD

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

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1861010845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9618 GARDEN GROVE BLVD STE 208",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441566",
            "telephone_number": "714-537-9380",
            "fax_number": "714-537-2593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9618 GARDEN GROVE BLVD STE 208",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928441566",
            "telephone_number": "714-537-9380",
            "fax_number": "714-537-2593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KIDEOG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "102006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jongsook Susie Park, MD
• Joo Ae Park, AMFT, RN
• Joonkyu Park, D.C.
• Joseph Park, DPT
• Jun Gyu Park, DDS
• Sanghoon Park, DDS
• Seonho Park
• Serena Park
• Stephen S Park, MD
• Steven Park

• General Practice Dentistry in Garden Grove, CA
• Providers in Garden Grove, 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 Jul 7, 2020; 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.