Jacqueline Sunja Prompton, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019031964 Issued in IL

Practice address

2400 N Ashland Ave. Suite 200
Chicago, IL 60614

Phone

(312) 500-5001

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jacqueline Sunja Park Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1184834996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 N ASHLAND AVE. SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "312-500-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N ASHLAND AVE. SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60614",
            "telephone_number": "312-500-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROMPTON",
        "first_name": "JACQUELINE",
        "middle_name": "SUNJA",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "16294",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019031964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "PARK",
            "middle_name": "SUNJA",
            "credential": "D.D.S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Promed Pharmacy Inc
• Promed Preferred Il 4 PLLC
• Promedix
• Promedix LLC
• Promontory Psychotherapy Inc
• Joshua Harper Prompton, DDS
• Veronica Pronitcheva
• Propel Psychotherapy, PLLC
• Proper Balance Healthcare
• Proper Balance Medical, LLC

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.