DR. SAM PARK D.D.S. NPI 1295871267

NPI Information

  • NPI: 1295871267
  • Provider Name: DR. SAM PARK, D.D.S.
  • Classification: Dentist - 1223P0221X
  • Specialization: Pediatric Dentistry
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2959 S WALLACE ST
    CHILDREN'S DENTAL WORLD
    CHICAGO, IL
    ZIP 60616
  • Phone: (312) 326-5437

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NPI Details

DR. Sam Park, D.D.S. is a pediatric dentistry dentist in Chicago, IL. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. DR. Sam Park, D.D.S. NPI is 1295871267. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2959 S WALLACE ST
CHILDREN'S DENTAL WORLD
CHICAGO, IL
ZIP 60616-034
Phone: (312) 326-5437
Fax: (312) 842-5338

The NPI 1295871267 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 1/29/2007 and was last updated on 8/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0221XDentistPediatric Dentistry021002099ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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