A Elite Dental, Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

1657387-9 Issued in OR

Legal business name

A ELITE DENTAL, INC

Practice address

3502 Excel Dr
#101
Medford, OR 97504-9136

Phone

(541) 690-1656

Fax

(541) 690-1658

NPI assigned

Mar 4, 2017

Last updated

Mar 4, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tae Kyung Jung, DMDNPI 1366537078

Title

President

Phone

(541) 690-1656

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tae Kyung Jung, DMD

  • Dentist
  • Medford, OR
  • NPI 1366537078
  Authorized official Same address or phone

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

{
    "created_epoch": "1488585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488585600000",
    "number": "1578003901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 EXCEL DR",
            "address_2": "#101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049136",
            "telephone_number": "541-690-1656",
            "fax_number": "541-690-1658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 EXCEL DR",
            "address_2": "#101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049136",
            "telephone_number": "541-690-1656",
            "fax_number": "541-690-1658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A ELITE DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-04",
        "last_updated": "2017-03-04",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "TAE",
        "authorized_official_middle_name": "KYUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-690-1656",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "1657387-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240506",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• A M M S Inc (Emerald Anesthesia Service)
• A Plus Medical Supply Inc
• Zachary Aalberg, PHARMD
• Kihili Aaron-Burden
• Charmaine Clarisse Dequito Abalos, M.D.

• Dental Clinic/Center in Medford, OR
• Providers in Medford, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2017; 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.