Sonrisa Family Dental on Kedzie PC

Primary specialty

DentistTaxonomy code 122300000X

License

01902511 Issued in IL

Legal business name

SONRISA FAMILY DENTAL ON KEDZIE PC

Practice address

5050 S Kedzie Ave
Chicago, IL 60632-3009

Phone

(773) 778-2200

NPI assigned

Apr 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jason Korkus, DDS

Title

President

Phone

(773) 778-2200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sonrisa Family Dental Doing business as

Locations

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1750554697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323009",
            "telephone_number": "773-778-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323009",
            "telephone_number": "773-778-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONRISA FAMILY DENTAL ON KEDZIE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "KORKUS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-778-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "01902511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004606",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sonrisa Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.