Jintae Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

5678 Issued in NV

Practice address

6795 S Virginia St
E
Reno, NV 89511-1171

Phone

(775) 853-0503

Fax

(775) 853-0504

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262995200000",
    "number": "1629110747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 KILEY RANCH PKWY",
            "address_2": "2901",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894364066",
            "telephone_number": "626-434-6150",
            "fax_number": "775-657-8619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6795 S VIRGINIA ST",
            "address_2": "E",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895111171",
            "telephone_number": "775-853-0503",
            "fax_number": "775-853-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JINTAE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2010-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "54686",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "5678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D54686",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dora Paredes Meneses
• Fernand Parent, PT, DPT
• Caitlin Anne Parenti, RDN
• Jonathan Parham, D.C.
• Coral Sue Paris, RN
• Ki Don Park, DDS
• Natasha Park, APRN
• Paul J Park, MD
• Seung Bai Park, O.M.D.
• Somakhanden Park, MI4032 AND CI5055

• Dentist in Reno, NV
• Providers in Reno, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.