Jenny Baruch DDS PC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

019028247 Issued in IL

Legal business name

JENNY BARUCH DDS PC

Practice address

805 S McHenry Ave
Ste 1
Crystal Lake, IL 60014-7450

Phone

(815) 477-2369

NPI assigned

Jun 3, 2010

Last updated

Mar 2, 2012By 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

Dr. Jenny Kwon Baruch, DDS

Title

Dentist

Phone

(815) 477-2369

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330646400000",
    "number": "1659691467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 S MCHENRY AVE",
            "address_2": "STE 1",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147450",
            "telephone_number": "815-477-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 S MCHENRY AVE",
            "address_2": "STE 1",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147450",
            "telephone_number": "815-477-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNY BARUCH DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-03",
        "last_updated": "2012-03-02",
        "status": "A",
        "authorized_official_last_name": "BARUCH",
        "authorized_official_first_name": "JENNY",
        "authorized_official_middle_name": "KWON",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "815-477-2369",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "IL",
            "license": "019028247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Exclusive Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; 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.