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

Last updated

Mar 13, 2024By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Park Dental Group, Inc

  dba Park Family Dental

  • 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.