NPIMap

Organization Active NPI

Ilcheon Joo DDS PC

  • Dental Clinic/Center
  • Pine Grove, PA
National Provider Identifier
1699006452
Registry record updated Jan 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DS037775 Issued in PA
Legal business name
ILCHEON JOO DDS PC
Practice address
46 Mifflin St
Pine Grove, PA 17963-1318
Phone
(570) 345-3495
Fax
(570) 345-3161
NPI assigned
Jan 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2010

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

Authorized official

Name
Dr. Ilcheon Joo, DDSNPI 1063530509
Title
President/Owner
Phone
(570) 345-3495

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
Dental Clinic/Center 261QD0000X DS037775 PA Primary

Addresses

Primary practice location

46 Mifflin St
Pine Grove, PA 17963-1318

Mailing address

46 Mifflin St
Pine Grove, PA 17963-1318
Phone (570) 345-3495

National Provider Directory

National Provider Directory

Practitioners 2

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": "1263859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263859200000",
    "number": "1699006452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 MIFFLIN ST",
            "city": "PINE GROVE",
            "state": "PA",
            "postal_code": "179631318",
            "telephone_number": "570-345-3495",
            "fax_number": "570-345-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 MIFFLIN ST",
            "city": "PINE GROVE",
            "state": "PA",
            "postal_code": "179631318",
            "telephone_number": "570-345-3495",
            "fax_number": "570-345-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILCHEON JOO DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-19",
        "last_updated": "2010-01-19",
        "status": "A",
        "authorized_official_last_name": "JOO",
        "authorized_official_first_name": "ILCHEON",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "570-345-3495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "PA",
            "license": "DS037775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Grove, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; 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.