DR. ERIC SONG JOON PARK (NPI# 1356560916) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356560916 |
| Entity Type | Individual |
| Full Name | DR. ERIC SONG JOON PARK |
| Credential | D.D.S. |
| Practice Address |
2180 Lake Tahoe Blvd South Lake Tahoe CA 96150-6418 |
| Practice Telephone | 5305413893 |
| Mailing Telephone | 5305413893 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
48533 | CA | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
4852 | NV | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144452830 | Eric Park | Dentist | 4935 Stewart Mill Rd, Suite 200, Douglasville, GA 30135-6733 | 2009-08-14 |
| 1780612283 | Eric Eungsoon Park | Acupuncturist | 30110 Crown Valley Pkwy, #107, Laguna Niguel, CA 92677-2043 | 2006-06-30 |
| 1932190766 | Eric J Park | Internal Medicine | 8600 Old Georgetown Rd, Bethesda, MD 20814-1422 | 2005-11-01 |
| Street Address |
2180 LAKE TAHOE BLVD |
| City | SOUTH LAKE TAHOE |
| State | CA |
| Zip Code | 96150-6418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750818969 | Terri Wong | Behavior Technician | 908 Alameda Ave, #b, South Lake Tahoe, CA 96150 | 2017-05-18 |
| 1154735157 | Catherine Anne Jones | Dental Hygienist | 1088 4th St # 6, South Lake Tahoe, CA 96150 | 2014-06-17 |
| 1245663194 | Sheila Marie Gwin | Behavioral Analyst | 2111south Ave, South Lake Tahoe, CA 96150 | 2013-08-14 |
| 1164785598 | Launa Jean Martin | Doula | 1399 Bozeman Dr, South Lake Tahoe, CA 96150 | 2012-06-20 |
| 1881957355 | Elizabeth Marilyn Mcnamara | Emergency Medicine | Barton Memorial Hospital, 2107 South Ave, South Lake Tahoe, CA 96150 | 2012-06-20 |
| 1295034627 | Dana Elizabeth Cox | Chiropractor | 3097 Harrison Ave., # 202, S. Lake Tahoe, CA 96150 | 2011-03-24 |
| 1639485162 | April Lyn Westfall | Dentist | 3358 Sandy Way, # B, S Lake Tahoe, CA 96150 | 2010-08-21 |
| 1700199270 | Rollie E Rohnow | Pharmacist | 1020 Al Tahoe Blvd, Rite Aid Pharmacy, South Lake Tahoe, CA 96150 | 2010-07-26 |
| 1699000455 | Ellen Newell Mccullough | Physical Therapist | 1900 High Meadow Trail, South Lake Tahoe, CA 96150 | 2009-10-13 |
| 1093941148 | Ashley Elizabeth Bedell | Counselor | 1137 Emerald Bay Rd., South Lake Tahoe, CA 96150 | 2009-06-03 |
| Find all providers in zip 96150 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184905861 | Hyun Myung Ha | Dentist | 2180 Lake Tahoe Blvd Ste 5, South Lake Tahoe, CA 96150-6409 | 2011-09-08 |
| 1912043076 | Lee Anne Stigers Genasci | Dentist | 2867 Lake Tahoe Blvd, South Lake Tahoe, CA 96150-7805 | 2007-01-29 |
| 1467501890 | Mireya Ortega | Dentist | 1060 Ski Run Blvd, South Lake Tahoe, CA 96150 | 2007-01-08 |
| 1467526285 | Donald Mineo Yamaoka | Dentist | 2101 South Avenue, South Lake Tahoe, CA 96150-7037 | 2006-11-20 |
| 1326127663 | Jason Randall Acevedo | Dentist | 3461 Lake Tahoe Blvd, #1, South Lake Tahoe, CA 96150 | 2006-11-06 |
| 1740299213 | Frederick Wenck | Dentist | 1116 Ski Run Blvd, Suite 1, South Lake Tahoe, CA 96150-8510 | 2006-08-05 |
| 1629091012 | Chris Allen Cerceo | Dentist | 1077 4th St, South Lake Tahoe, CA 96150-3459 | 2006-07-26 |
| 1568437200 | Ross W. Groelz | Dentist | 2074 Lake Tahoe Blvd, Suite #4, South Lake Tahoe, CA 96150-6407 | 2006-02-17 |
| 1043201270 | Jeff Chamberlain | Dentist | 3170 Us Highway 50, Suite 3, South Lake Tahoe, CA 96150-9214 | 2005-11-05 |
| 1336149970 | Timothy R Durkin | Dentist | 3443 Lake Tahoe Blvd, Suite #b, South Lake Tahoe, CA 96150-8910 | 2005-07-26 |
| Find all providers in SOUTH LAKE TAHOE | ||||
| City | SOUTH LAKE TAHOE |
| Zip Code | 96150 |
Please comment or provide details below to improve the information on DR. ERIC SONG JOON PARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.