Active NPI
Hyun W Park, DDS
- General Practice Dentistry
- Monroe, GA
National Provider Identifier
1881773679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN12810
- Practice address
- 256 N Hammond Dr
Monroe, GA 30655-2475 - Phone
- (770) 207-0008
- Fax
- (770) 207-0033
- NPI assigned
- Nov 3, 2006
- Last updated
- Jan 25, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN12810 | GA | Primary |
Addresses
Primary practice location
256 N Hammond Dr
Monroe, GA 30655-2475
Mailing address
256 N Hammond Dr
Monroe, GA 30655-2475
Phone (770) 207-0008
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 858480563A | Medicaid | GA | |
| 858480563B | Medicaid | GA | |
| 858480563C | Medicaid | GA |
Other names 1
- Mike Park
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN12810 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Dental Group | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327449600000",
"number": "1881773679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "256 N HAMMOND DR",
"city": "MONROE",
"state": "GA",
"postal_code": "306552475",
"telephone_number": "770-207-0008",
"fax_number": "770-207-0033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "256 N HAMMOND DR",
"city": "MONROE",
"state": "GA",
"postal_code": "306552475",
"telephone_number": "770-207-0008",
"fax_number": "770-207-0033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "HYUN",
"middle_name": "W",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2012-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN12810",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "858480563A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "858480563B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "858480563C",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MIKE",
"last_name": "PARK",
"credential": "DDS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Monroe, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.