Jae Sung Roh, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026367 Issued in IL

Practice address

24047 W Lockport St Ste 207
Plainfield, IL 60544-1683

Phone

(815) 267-7878

Fax

(815) 267-7979

NPI assigned

Oct 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Park Dental Group, Inc

  • Dentist
  • Plainfield, IL
  • NPI 1588986418
  NPD Authorized official

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1790773117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24047 W LOCKPORT ST STE 207",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605441683",
            "telephone_number": "815-267-7878",
            "fax_number": "815-267-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24047 W LOCKPORT ST STE 207",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605441683",
            "telephone_number": "815-267-7878",
            "fax_number": "815-267-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROH",
        "first_name": "JAE",
        "middle_name": "SUNG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Rodriguez, MS
• Victor I Rodriguez, PT
• Rogers Medical, LTD
• Courtney Rogers
• Jennifer Rogers, LPC
• Brenda Roman
• Rooted Counseling LLC
• Rooted Presence and Purpose, LLC
• Jordan Roscoe, RBT
• Madalyn Joy Rossen, MS

• General Practice Dentistry in Plainfield, IL
• Providers in Plainfield, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.