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1649167123 NPI number — ANGELA HYOEUN PARK DMD

NPI Number: 1649167123
Health Care Provider/Practitioner: ANGELA HYOEUN PARK DMD

Information about “1649167123” NPI (ANGELA HYOEUN PARK DMD) exists in 1649167123 in HTML format HTML  |  1649167123 in plain Text format TXT  |  1649167123 in PDF (Portable Document Format) PDF  |  1649167123 in an XML format XML  formats.

NPI Number : 1649167123 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649167123",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PARK",
    "FirstName": "ANGELA",
    "MiddleName": "HYOEUN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1313 GLENTHORPE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WALNUT",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91789-3859",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-938-2152",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6437 E PACIFIC COAST HWY UNIT A-6",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LONG BEACH",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90803-4201",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "562-280-5200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/18/2025",
    "LastUpdateDate": "06/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "111663",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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