Jin Park DDS, Inc

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

47406 Issued in CA

Legal business name

JIN PARK DDS, INC

Practice address

2727 W Olympic Blvd
301
Los Angeles, CA 90006-2637

Phone

(213) 385-8000

NPI assigned

Apr 5, 2007

Organization subpart

No

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

Authorized official

Name

Jin Park

Title

Ceo

Phone

(213) 385-8000

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1255453668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2727 W OLYMPIC BLVD",
            "address_2": "301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062637",
            "telephone_number": "213-385-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 W OLYMPIC BLVD",
            "address_2": "301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062637",
            "telephone_number": "213-385-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIN PARK DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-05",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "213-385-8000"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "47406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D47406",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA CHILDREN'S SERVICES",
            "identifier": "47406",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.