NPIMap

Organization Active NPI

Juwon Park DMD PC

  • Pediatric Dentistry
  • Albany, NY
National Provider Identifier
1578045258
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
056491 Issued in NY
Legal business name
JUWON PARK DMD PC
Practice address
4 Executive Park Dr
Albany, NY 12203-3718
Phone
(347) 408-8673
NPI assigned
Aug 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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

Authorized official

Name
John Juwon Park, DMDNPI 1083866982
Title
President
Phone
(347) 408-8673

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 056491 NY Primary

Addresses

Primary practice location

4 Executive Park Dr
Albany, NY 12203-3718

Mailing address

255 Patroon Creek Blvd Apt 1405
Albany, NY 12206-5019
Phone (347) 408-8673

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535587200000",
    "number": "1578045258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 PATROON CREEK BLVD APT 1405",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122065019",
            "telephone_number": "347-408-8673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 EXECUTIVE PARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033718",
            "telephone_number": "347-408-8673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUWON PARK DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-30",
        "last_updated": "2018-08-30",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JUWON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-408-8673",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "056491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; 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.