Jic Dental Care

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS030832L Issued in PA

Legal business name

JIC DENTAL CARE

Practice address

37B Garrett Rd
Upper Darby, PA 19082-2302

Phone

(610) 352-4091

NPI assigned

Aug 3, 2016

Organization subpart

Yes

Parent organization

JANG'S DENTAL CAREAs reported in NPPES

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

Authorized official

Name

Dr. Young Soo Jang, DMD

Title

Owner

Phone

(267) 632-5774

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Jic Dental Care

Locations

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

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470182400000",
    "number": "1477006799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37B GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822302",
            "telephone_number": "610-352-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37B GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822302",
            "telephone_number": "610-352-4091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIC DENTAL CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JANG'S DENTAL CARE",
        "enumeration_date": "2016-08-03",
        "last_updated": "2016-08-03",
        "status": "A",
        "authorized_official_last_name": "JANG",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "SOO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "267-632-5774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS030832L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023390590001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kamilah Jackson
• Sherita Marie Jamison, MSW
• William Jarwood, Sr., MA
• Delva Jean-Baptiste
• Adjani Diana Mone Jenkins, LSW
• Paramjit Singh Jittla
• Shubhsangeet Kaur Johal, DMD
• Jerome Johnson Griffin
• Kimberley Celeste Johnson
• Lewis Johnson, LPC, NCC

• General Practice Dentistry in Upper Darby, PA
• Providers in Upper Darby, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; 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.