DR. CHAN M PARK (NPI# 1871617027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871617027 |
| Entity Type | Individual |
| Full Name | DR. CHAN M PARK |
| Credential | MD |
| Practice Address |
111 Deerwood Rd Ste 130 San Ramon CA 94583-2194 |
| Practice Telephone | 9252174884 |
| Practice Fax Number | 9252174895 |
| Mailing Telephone | 9252174884 |
| Mailing Fax Number | 9252174895 |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2019-10-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
54673 | CA | Dental Providers |
| Y | 204E00000X | Oral & Maxillofacial Surgery | A109104 | CA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144828963 | Chan Ho Park | Physician Assistant | 4721 Oakwood Ave, Los Angeles, CA 90004-3112 | 2020-10-14 |
| 1508404492 | Chan Jin Park | Acupuncturist | 21537 48th Ave Apt 2b, Bayside, NY 11364-1359 | 2019-12-11 |
| 1700147378 | Chan H Park | Internal Medicine | 22226 Cliff Ave S, #304, Des Moines, WA 98198-4619 | 2012-05-30 |
| 1760644280 | Chan Woo Park | Otolaryngology | 90 Bergen Street- Suite 8100, Department of Otolaryngology, Doc Building, Newark, NJ 07103 | 2008-06-26 |
| 1700092103 | Chan Hoon Park | Family Medicine | 905 Victory Hwy, Slatersville, RI 02876 | 2007-05-15 |
| 1457467037 | Chan M Park | Family Medicine | 6460 Greensboro Rd, Ridgeway, VA 24148-3478 | 2006-08-23 |
| 1619940681 | Chan S. Park | Emergency Medicine | Michumi, Pllc Dba Med Express of Williamsburg, Va, 120 Monticello Ave, Williamsburg, VA 23185 | 2006-02-09 |
| 1255336665 | Chan H. Park | Family Medicine | 9500 Stockdale Hwy, Suite 203, Bakersfield, CA 93311-3620 | 2005-06-14 |
| 1366071045 | Chan Young Park | Student in an Organized Health Care Education/Training Program | 11301 Wilshire Blvd Bldg 500, Los Angeles, CA 90073-1003 | 2020-04-05 |
| 1932498722 | Chan Jerome Park | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 600 Highland Ave, Madison, WI 53792-0001 | 2011-03-31 |
| Street Address |
111 DEERWOOD RD STE 130 |
| City | SAN RAMON |
| State | CA |
| Zip Code | 94583-2194 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124660014 | Chan M. Park, D.d.s., M.d., PC and Benjamin R. Shimel, D.d.s., PC A Pa | Dentist | 111 Deerwood Rd Ste 130, San Ramon, CA 94583-2194 | 2019-10-11 |
| 1023495637 | Benjamin Ryan Shimel | Dentist | 111 Deerwood Rd Ste 130, San Ramon, CA 94583-2194 | 2015-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295375475 | Angel Beatrice Mckneely | Behavior Technician | 3150 Crow Canyon Place, Suite 110, San Ramon, CA 94583 | 2020-01-15 |
| 1205302247 | Asma Parisa Rezaye | Behavior Technician | 4708 Norris Canyon Rd, Unit 201, San Ramon, CA 94583 | 2018-10-17 |
| 1679055461 | Mary Martineau | Speech-Language Pathologist | 210 Porter Dr Ste 120, San Ramon, CA 94583 | 2018-08-29 |
| 1336631332 | Alison Jean Barnes | Behavior Technician | Goals for Autism, 1 Crow Canyon Court, San Ramon, CA 94583 | 2018-06-05 |
| 1730671975 | Michael Federico | Pharmacist | 2735 Ascot Drive, San Ramon, CA 94583 | 2018-06-04 |
| 1508384843 | Donor Network West | Organ Procurement Organization | 12667 Alcosta Blvd., Suite 500, San Ramon, CA 94583 | 2017-09-07 |
| 1265950141 | Danielle Lustig Fitch | Marriage & Family Therapist | 3180 Crown Canyon Pl. Ste 140, San Ramon, CA 94583 | 2017-08-31 |
| 1386166205 | Park Place Ambulatory Surgery Center | Orthopaedic Surgery | 100 Park Place, Suite 100, San Ramon, CA 94583 | 2017-07-12 |
| 1952822991 | Virginia Rutledge Mosby | Marriage & Family Therapist | 3180 Crow Canyon Place #140, San Ramon, CA 94583 | 2017-06-29 |
| 1437684784 | Nakhla Dental Group | Dentist | Crow Canyon Dental, 2821 Crow Canyon Road #200, San Ramon, CA 94583 | 2017-04-25 |
| Find all providers in zip 94583 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457983025 | Olena Norris Dds Dental Corporation | Oral & Maxillofacial Surgery | 5060 California Ave Ste 202, Bakersfield, CA 93309-7087 | 2020-02-11 |
| 1306498829 | Henry Mayo Newhall Clinics, LLC | Oral & Maxillofacial Surgery | 25751 Mcbean Pkwy Ste 220, Valencia, CA 91355-3701 | 2019-07-15 |
| 1396211926 | Fremont Oral & Maxillofacial Surgery | Oral & Maxillofacial Surgery | 39210 State St Ste 115, Fremont, CA 94538-1456 | 2018-10-22 |
| 1013495985 | Ned L. Nix, Dds, Inc | Oral & Maxillofacial Surgery | 704 Blossom Hill Rd Ste 102, San Jose, CA 95123-5403 | 2018-08-02 |
| 1811475759 | University of California Sfgh Medical Group | Oral & Maxillofacial Surgery | 1001 Potrero Avenue, Bldg 5, Room 1n1, San Francisco, CA 94110-3518 | 2018-08-02 |
| 1235649690 | Mac Dental Corporation | Oral & Maxillofacial Surgery | 9855 Erma Road, #110, Scripps Periodontics, San Diego, CA 92131 | 2017-10-11 |
| 1710354162 | Michael J. Belton Dds,md Inc. | Oral & Maxillofacial Surgery | 2045 Compton Ave Ste 102, Corona, CA 92881-7293 | 2015-09-01 |
| 1508263740 | F.a.c.e. Surgical Center of The Desert | Oral & Maxillofacial Surgery | 1900 E Tahquitz Canyon Way Ste C4, Palm Springs, CA 92262-7062 | 2014-12-03 |
| 1407114499 | Niloofar Deyhim | Oral & Maxillofacial Surgery | 853 Middlefield Rd Ste 1, Palo Alto, CA 94301-2900 | 2012-04-26 |
| 1437479144 | Brian Robert Carr | Oral & Maxillofacial Surgery | 521 Parnassus Ave # C-522, San Francisco, CA 94143-0440 | 2010-06-03 |
| Find all providers with the same taxonomy | ||||
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| 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.