Park Avenue Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

34127 Issued in CA

Legal business name

PARK AVENUE FAMILY DENTISTRY

Doing business as

Park Avenue Family Dentistry

Practice address

1087 N Park Ave
Pomona, CA 91768-3026

Phone

(909) 629-0201

NPI assigned

Dec 6, 2007

Last updated

Dec 6, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Soedharsono Judo, D.D.S.NPI 1093873218

Title

Owner

Phone

(909) 629-0201

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Park Avenue Family Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Soedharsono Judo, DDS

  • Dentist
  • Pomona, CA
  • NPI 1093873218
  NPD (past) Authorized official
• Teresita Jahja Judo, DDS

  • Dentist
  • Pomona, CA
  • NPI 1538235635
  NPD (past)

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

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1205019858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1087 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683026",
            "telephone_number": "909-629-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1087 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683026",
            "telephone_number": "909-629-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "JUDO",
        "authorized_official_first_name": "SOEDHARSONO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-629-0201",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "34127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9044501",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Avenue Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Akhenaton Pappoe, M.D
• Victor L Pappoe, MD
• Katelyn Pardon Arrant, DO
• Mehul Parekh, B.A.
• Gaurav R Parikh, MD
• Park Avenue Optometry Inc
• James Park, LCSW
• Janice Hyan Park
• John Jongcheol Park, DDS
• Joseph Park, DPM

• General Practice Dentistry in Pomona, CA
• Providers in Pomona, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; 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.