Active NPI
Jin-Sir Park, D.D.S
- Endodontics
- Hackettstown, NJ
National Provider Identifier
1730364068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 22DI02177900
- Practice address
- 254B Mountain Ave
Suite 206
Hackettstown, NJ 07840-2413 - Phone
- (908) 850-6300
- Fax
- (908) 850-6399
- NPI assigned
- Jan 6, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 22DI02177900 | NJ | Primary |
Addresses
Primary practice location
254B Mountain Ave
Suite 206
Hackettstown, NJ 07840-2413
Mailing address
254B Mountain Ave
Suite 206
Hackettstown, NJ 07840-2413
Phone (908) 850-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02177900 | NJ | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237161600000",
"number": "1730364068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "254B MOUNTAIN AVE",
"address_2": "SUITE 206",
"city": "HACKETTSTOWN",
"state": "NJ",
"postal_code": "078402413",
"telephone_number": "908-850-6300",
"fax_number": "908-850-6399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "254B MOUNTAIN AVE",
"address_2": "SUITE 206",
"city": "HACKETTSTOWN",
"state": "NJ",
"postal_code": "078402413",
"telephone_number": "908-850-6300",
"fax_number": "908-850-6399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JIN-SIR",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-06",
"last_updated": "2009-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NJ",
"license": "22DI02177900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hackettstown, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.