NPIMap

Organization Active NPI

Tigard City Dental PC

  • Dentist
  • Tigard, OR
National Provider Identifier
1184071003
Registry record updated May 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D6995 Issued in OR
Legal business name
TIGARD CITY DENTAL PC
Practice address
11565 SW Hall Blvd
Ste a
Tigard, OR 97223-8493
Phone
(503) 620-2131
Fax
(503) 620-0505
NPI assigned
May 20, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2016

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

Authorized official

Name
Dr. John D Chung, DDS
Title
Owner
Phone
(503) 679-7730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D6995 OR Primary

Addresses

Primary practice location

11565 SW Hall Blvd
Ste a
Tigard, OR 97223-8493

Mailing address

11565 SW Hall Blvd
Ste a
Tigard, OR 97223-8493
Phone (503) 620-2131

National Provider Directory

National Provider Directory

Locations

11565 SW Hall Blvd
Ste A
Tigard, OR 97223
Phone (503) 620-2131

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1184071003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11565 SW HALL BLVD",
            "address_2": "STE A",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238493",
            "telephone_number": "503-620-2131",
            "fax_number": "503-620-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11565 SW HALL BLVD",
            "address_2": "STE A",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238493",
            "telephone_number": "503-620-2131",
            "fax_number": "503-620-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIGARD CITY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-20",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-679-7730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; 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.