Active NPI
Jae Yeon Park, DMD
- General Practice Dentistry
- Atlanta, GA
National Provider Identifier
1205096203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22145
- Practice address
- 400 Galleria Pkwy SE Ste 800
Atlanta, GA 30339-6413 - Phone
- (800) 920-9947
- Fax
- (678) 904-5666
- NPI assigned
- Jun 12, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22145 | MA | Primary |
Addresses
Primary practice location
400 Galleria Pkwy SE Ste 800
Atlanta, GA 30339-6413
Mailing address
15 Parkside PL Apt 428
Revere, MA 02151-1154
Phone (339) 223-5869
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 |
|---|---|---|---|
| 22145 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1205096203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 PARKSIDE PL APT 428",
"city": "REVERE",
"state": "MA",
"postal_code": "021511154",
"telephone_number": "339-223-5869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 GALLERIA PKWY SE STE 800",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303396413",
"telephone_number": "800-920-9947",
"fax_number": "678-904-5666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JAE YEON",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-12",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "22145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.