NPIMap

Organization Active NPI

Sang Paik DDS, Inc

Doing business as San Jacinto Dental Center

  • General Practice Dentistry
  • San Jacinto, CA
National Provider Identifier
1255544052
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41861 Issued in CA
Legal business name
SANG PAIK DDS, INC
Doing business as
San Jacinto Dental Center
Practice address
166 E Main St
Suite 6
San Jacinto, CA 92583-4200
Phone
(951) 654-8005
Fax
(951) 654-3680
NPI assigned
May 8, 2007
Last updated
Aug 22, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

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

Authorized official

Name
Dr. Jason Lee, DDS
Title
Cfo
Phone
(951) 654-8005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 41861 CA Primary

Addresses

Primary practice location

166 E Main St
Suite 6
San Jacinto, CA 92583-4200

Mailing address

166 E Main St
Suite 6
San Jacinto, CA 92583-4200
Phone (951) 654-8005

Other identifiers 1

IdentifierTypeStateIssuer
B41861-02MedicaidCA

Other names 1

  • San Jacinto Dental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eagle Glen Dental Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1255544052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 E MAIN ST",
            "address_2": "SUITE 6",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925834200",
            "telephone_number": "951-654-8005",
            "fax_number": "951-654-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 E MAIN ST",
            "address_2": "SUITE 6",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925834200",
            "telephone_number": "951-654-8005",
            "fax_number": "951-654-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANG PAIK DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "951-654-8005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B41861-02",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Jacinto Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jacinto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.