Active NPI
Jacky Lung
- Orthodontics and Dentofacial Orthopedics Dentistry
- Santa Fe, NM
National Provider Identifier
1164378055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DB-2025-0259
- Practice address
- 1439 S Saint Francis Dr
Santa Fe, NM 87505-4037 - Phone
- (505) 473-5437
- NPI assigned
- Mar 5, 2026
- Last updated
- Mar 5, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DB-2025-0259 | NM | Primary |
Addresses
Primary practice location
1439 S Saint Francis Dr
Santa Fe, NM 87505-4037
Mailing address
955 Richards Ave Apt 1016
Santa Fe, NM 87507-6213
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DB-2025-0259 | NM | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Whole Child Dental, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1772668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772668800000",
"number": "1164378055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "955 RICHARDS AVE APT 1016",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875076213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1439 S SAINT FRANCIS DR",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875054037",
"telephone_number": "505-473-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNG",
"first_name": "JACKY",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-03-05",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NM",
"license": "DB-2025-0259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.