Olivia Jin-Young Park, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

61769 Issued in CA

Practice address

1110 E Lerdo Hwy # 200
Shafter, CA 93263-9415

Phone

(661) 746-6989

NPI assigned

Aug 20, 2012

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 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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: opark@direct.westerndental.com

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.

• Olivia Park Dental Corporation

  • Dental Clinic/Center
  • Shafter, CA
  • NPI 1083368765
  NPD Authorized official
• Western Dental Services, Inc.

  • General Practice Dentistry
  • Bakersfield, CA
  • NPI 1174687313
  NPD (past)

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1982952198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 E LERDO HWY # 200",
            "city": "SHAFTER",
            "state": "CA",
            "postal_code": "932639415",
            "telephone_number": "661-746-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 E LERDO HWY # 200",
            "city": "SHAFTER",
            "state": "CA",
            "postal_code": "932639415",
            "telephone_number": "661-746-6989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4401 Ming Ave",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933094817",
            "country_code": "US",
            "telephone_number": "661-397-7400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "OLIVIA",
        "middle_name": "JIN-YOUNG",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DENTAL BOARD",
            "identifier": "61769",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Omni Family Health
• Omni Family Health
• Agnes Gan Ong, D.M.D.
• Mia Valerie Ortiz
• Chan H. Park, M.D.
• Parrott Gordon & Associates L.P.
• Bhadraksh P Patel
• Amy Peraza, CD
• Lutgarda O. Perez, DDS
• Hung Tony Pham, PA

• Dentist in Shafter, CA
• Providers in Shafter, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.