Jong Yun Park PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN20765 Issued in FL

Legal business name

JONG YUN PARK PLLC

Practice address

11806 Atlantic Blvd
Jacksonville, FL 32225-2918

Phone

(315) 454-6000

Fax

(315) 438-4483

NPI assigned

Oct 30, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mika Weiss

Title

Provider Relations

Phone

(315) 454-6000

Specialties & licenses 1

Addresses

Other names 1

• Aspen Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1043615107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11806 ATLANTIC BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252918",
            "telephone_number": "315-454-6000",
            "fax_number": "315-438-4483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11806 ATLANTIC BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252918",
            "telephone_number": "315-454-6000",
            "fax_number": "315-438-4483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONG YUN PARK PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "MIKA",
        "authorized_official_title_or_position": "PROVIDER RELATIONS",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN20765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William Ottis Jones, RPH
• Yekaterina Jones, D.O.
• Youlanda Jones
• Zianni Jones
• Jonesin FL LLC
• Elton Jonuzaj, PA-C
• Veronica Adriana Jonuzaj, PA-C
• Alison Jordan
• Arnetia Mitchell Jordan
• Brittany Renee Jordan

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.