So-Yeon Park, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019026733 Issued in IL

Practice address

2316 W Madison St
Chicago, IL 60612-2228

Phone

(312) 491-0601

Fax

(312) 491-0602

NPI assigned

Jan 30, 2007

Last updated

Feb 9, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Practice roles

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.

• Ash Dental PC

  dba all star dental clinic

  • Dentist
  • Chicago, IL
  • NPI 1053584599
  NPD (past)
• Jihye Lee, D.D.S., P.C.

  dba Essence Dentistry

  • Dentist
  • Glenview, IL
  • NPI 1316103252
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1982741112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 MILWAUKEE AVE",
            "address_2": "STE 185",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600257801",
            "telephone_number": "847-998-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 W MADISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122228",
            "telephone_number": "312-491-0601",
            "fax_number": "312-491-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SO-YEON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9179986",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sam Park, D.D.S.
• Sang Park, D.D.S.
• Sarah Park, MD
• Seong Park
• Simon Park
• Solmi Park
• Sook Hyeon Park, M.D.
• Soyeon Park, MD
• Sue Bin Park, DDS
• Sue M Park, APN

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; 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.