Active NPI
Jun Hyeong Park, DDS
- General Practice Dentistry
- Oakland, CA
National Provider Identifier
1497925739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 46919
- Practice address
- 2710 Telegraph Ave
250
Oakland, CA 94612 - Phone
- (510) 839-6090
- NPI assigned
- Mar 3, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 46919 | CA | Primary |
Addresses
Primary practice location
2710 Telegraph Ave
250
Oakland, CA 94612
Mailing address
2710 Telegraph Ave
#250
Oakland, CA 94612
Phone (510) 839-6090
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 |
|---|---|---|---|
| 46919 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204502400000",
"number": "1497925739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2710 TELEGRAPH AVE",
"address_2": "#250",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94612",
"telephone_number": "510-839-6090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2710 TELEGRAPH AVE",
"address_2": "250",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94612",
"telephone_number": "510-839-6090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JUN",
"middle_name": "HYEONG",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-03",
"last_updated": "2008-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "46919",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.