NPIMap

Organization Active NPI

Ian Park DDS PA

  • General Practice Dentistry
  • Minnetonka, MN
National Provider Identifier
1891986378
Registry record updated Aug 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9986 Issued in MN
Legal business name
IAN PARK DDS PA
Practice address
17705 Hutchins Dr
Suite 209
Minnetonka, MN 55345-4145
Phone
(952) 474-8114
NPI assigned
Aug 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ian A Park, DDSNPI 1861494791
Title
Owner
Phone
(952) 474-8114

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 9986 MN Primary

Addresses

Primary practice location

17705 Hutchins Dr
Suite 209
Minnetonka, MN 55345-4145

Mailing address

17705 Hutchins Dr
Suite 209
Minnetonka, MN 55345-4145
Phone (952) 474-8114

National Provider Directory

National Provider Directory

Locations

17705 Hutchins Dr
Ste 209
Minnetonka, MN 55345
Phone (925) 474-8114

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186531200000",
    "number": "1891986378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR",
            "address_2": "SUITE 209",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454145",
            "telephone_number": "952-474-8114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR",
            "address_2": "SUITE 209",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454145",
            "telephone_number": "952-474-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IAN PARK DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2007-08-08",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-474-8114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2007; 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.