NPIMap

Organization Active NPI

Jun Park D.D.S.,P.a.

  • General Practice Dentistry
  • Lutherville, MD
National Provider Identifier
1609258722
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13401 Issued in MD
Legal business name
JUN PARK D.D.S.,P.A.
Practice address
1205 York Rd
Suite 25a
Lutherville, MD 21093-6210
Phone
(410) 321-6120
Fax
(410) 321-6121
NPI assigned
Jun 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Authorized official

Name
Dr. Jun Y Park, D.D.S.NPI 1548443831
Title
Head Dentist
Phone
(410) 321-6120

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 13401 MD Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 15632 MD

Addresses

Primary practice location

1205 York Rd
Suite 25a
Lutherville, MD 21093-6210

Mailing address

1205 York Rd
Suite 25a
Lutherville, MD 21093-6210
Phone (410) 321-6120

Other identifiers 1

IdentifierTypeStateIssuer
1548443831MedicaidMD

National Provider Directory

National Provider Directory

Locations

1205 York Rd
Ste 25A
Timonium, MD 21093
Phone (410) 321-6120

Practitioners & affiliated clinicians

Practitioners 3

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": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1609258722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 YORK RD",
            "address_2": "SUITE 25A",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936210",
            "telephone_number": "410-321-6120",
            "fax_number": "410-321-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 YORK RD",
            "address_2": "SUITE 25A",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936210",
            "telephone_number": "410-321-6120",
            "fax_number": "410-321-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUN PARK D.D.S.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-25",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JUN",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "HEAD DENTIST",
        "authorized_official_telephone_number": "410-321-6120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "13401",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "15632",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548443831",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutherville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; 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.