David S Park, DDS, MPH

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

53724 Issued in CA

Practice address

10390 Coloma Rd Ste a
Rancho Cordova, CA 95670-2152

Phone

(916) 368-0440

Fax

(916) 368-0440

NPI assigned

May 23, 2007

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

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": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385510400000",
    "number": "1942410501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 VIA DEL CIELO",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902752511",
            "telephone_number": "310-403-1117",
            "fax_number": "310-403-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10390 COLOMA RD STE A",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956702152",
            "telephone_number": "916-368-0440",
            "fax_number": "916-368-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DAVID",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS, MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2013-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antwan Padilla
• Justin Paige
• Panacea, Inc.
• Malissa Sue Pardo, LMFT
• Steven Parella Jr., PHARMD
• Edwin Park
• Junsuk Park, DDS
• Destiny Myisha Parker
• Dorota Parker
• Karen Arlene Passerino

• General Practice Dentistry in Rancho Cordova, CA
• Providers in Rancho Cordova, 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 Nov 27, 2013; 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.