Active NPI
Peter Park, D.D.S.
- Dental Anesthesiology
- Covina, CA
National Provider Identifier
1992181598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- 64710
- Practice address
- 246 W College St
Covina, CA 91723-1910 - Phone
- (626) 966-2222
- NPI assigned
- Aug 5, 2015
- 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 |
|---|---|---|---|---|
| Dental Anesthesiology | 1223D0004X | 64710 | CA | Primary |
Addresses
Primary practice location
246 W College St
Covina, CA 91723-1910
Mailing address
26061 Lawton Ave
Loma Linda, CA 92354-3836
Phone (423) 322-7394
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 |
|---|---|---|---|
| 64710 | CA | MD | Dentist Anesthesiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438732800000",
"number": "1992181598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26061 LAWTON AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543836",
"telephone_number": "423-322-7394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "246 W COLLEGE ST",
"city": "COVINA",
"state": "CA",
"postal_code": "917231910",
"telephone_number": "626-966-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "PETER",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-05",
"last_updated": "2015-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "CA",
"license": "64710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.