CHAN M. PARK, D.D.S., M.D., PC AND BENJAMIN R. SHIMEL, D.D.S., PC A PA
NPI 1124660014
Dentist - Oral and Maxillofacial Surgery in San Ramon, CA

Q: What is Chan M. Park, D.D.S., M.D., PC And Benjamin R. Shimel, D.D.S., PC A PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since October 11, 2019

111 DEERWOOD RD STE 130, SAN RAMON, CA 94583(925) 217-4884(925) 217-4895 Get Directions Write a Review

NPPES record last updated: October 11, 2019. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Chan M. Park, D.d.s., M.d., Pc And Benjamin R. Shimel, D.d.s., Pc A Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHAN M. PARK, D.D.S., M.D., PC AND BENJAMIN R. SHIMEL, D.D.S., PC A PA (NPI 1124660014), doing business as Sycamore Oral & Maxillofacial Surgery, is a healthcare organization registered as an oral and maxillofacial surgery in San Ramon, California and active in the NPI registry since October 2019. The organization lists Chan M Park, Partner, as its authorized official.

NPPES Registry Identity

NPI1124660014

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameCHAN M. PARK, D.D.S., M.D., PC AND BENJAMIN R. SHIMEL, D.D.S., PC A PA

Location Address111 DEERWOOD RD STE 130San Ramon, CA 94583-2194

Mailing Address111 Deerwood Rd Ste 130San Ramon, CA 94583-2194 · (925) 217-4884 · Fax (925) 217-4895

Phone(925) 217-4884

Fax(925) 217-4895

Organization SubpartNo

Authorized OfficialChan M ParkPartner · (925) 217-4884

Enumeration DateOctober 11, 2019

✔ NPI 1124660014 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

111 DEERWOOD RD STE 130, San Ramon, CA 94583

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Other Names 1

Doing Business AsSycamore Oral & Maxillofacial Surgery

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BENJAMIN RYAN SHIMEL DDS

Dentist (Oral and Maxillofacial Surgery)

111 DEERWOOD RD STE 130
SAN RAMON, CA 94583

Contra Costa County (925) 217-4884

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Chan M. Park, D.D.S., M.D., PC And Benjamin R. Shimel, D.D.S., PC A PA's NPI number?

The NPI number for Chan M. Park, D.D.S., M.D., PC And Benjamin R. Shimel, D.D.S., PC A PA is 1124660014. It was assigned to this organization in the NPPES registry on October 11, 2019. The provider is doing business as Sycamore Oral & Maxillofacial Surgery.

Where is Chan M. Park, D.D.S., M.D., PC And Benjamin R. Shimel, D.D.S., PC A PA located?

Chan M. Park, D.D.S., M.D., PC And Benjamin R. Shimel, D.D.S., PC A PA is located at 111 Deerwood Rd Ste 130, San Ramon, CA 94583. The listed phone number is (925) 217-4884.

What is Chan M. Park, D.D.S., M.D., PC And Benjamin R. Shimel, D.D.S., PC A PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for Chan M. Park, D.D.S., M.D., PC And Benjamin R. Shimel, D.D.S., PC A PA was last updated on October 11, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.