Jae W Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401414774 Issued in VA

Practice address

114 N Franklin St
Christiansburg, VA 24073-2953

Phone

(540) 382-6108

NPI assigned

Aug 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peter J McDonald DDS PC

  • General Practice Dentistry
  • Christiansburg, VA
  • NPI 1457495780
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433116800000",
    "number": "1144232968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 N FRANKLIN ST",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240732953",
            "telephone_number": "540-382-6108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 N FRANKLIN ST",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240732953",
            "telephone_number": "540-382-6108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JAE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2015-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401414774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Leonard Owen, PHD
• Diana Padget, DO
• Caleb Pagliasotti, M.D.
• Pain MD LLC
• Prajwol Raj Pant, MD
• Sohyun C Park, PHARMD
• Melanie D Parks, DNP, FNP, PMHNP
• Bharat R Patel, M.D.
• Krista Pattison
• Peace of Mind Psychotherapy Services LLC

• Dentist in Christiansburg, VA
• Providers in Christiansburg, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.