JC Park DDS Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

JC PARK DDS INC

Practice address

1505 S Riverside Ave Unit B
Rialto, CA 92376-7725

Phone

(909) 440-5345

NPI assigned

Mar 22, 2024

Last updated

Mar 22, 2024By 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

Jaechan Park, DDSNPI 1275666315

Title

Ceo

Phone

(626) 454-0159

Specialties & licenses 1

Addresses

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.

• Jaechan Park, D.D.S.

  • General Practice Dentistry
  • Gardena, CA
  • NPI 1275666315
  NPD Authorized official

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1609636810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15201 S WESTERN AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902494314",
            "telephone_number": "310-400-7705",
            "fax_number": "310-400-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 S RIVERSIDE AVE UNIT B",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923767725",
            "telephone_number": "909-440-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JC PARK DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JAECHAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-454-0159",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Eric Jackson, MFC52239
• Alma Rosa Jacobo
• Bozena Grazyna Janczar, DC
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• JC Max Pharmacy Inc (ABC Pharmacy)
• David Chih-Yuan Jen, D.D.S.
• Annette Allen Jenkins, LMFT
• Tisha Jenyo, LPT
• JH Kim Dental Professional Corp.
• Catrina Johnson-Coleman, LPCC

• Dental Clinic/Center in Rialto, CA
• Providers in Rialto, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.