Jae Hyun Park, DMD, PHD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

7019 Issued in AZ

Practice address

3155 W Indian School Rd
Western Dental Orthodontic Office
Phoenix, AZ 85017-4035

Phone

(480) 286-0455

NPI assigned

Dec 1, 2006

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811065238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5519 E BERYL AVE",
            "city": "PARADISE VALLEY",
            "state": "AZ",
            "postal_code": "852531165",
            "telephone_number": "480-286-0455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 W INDIAN SCHOOL RD",
            "address_2": "WESTERN DENTAL ORTHODONTIC OFFICE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850174035",
            "telephone_number": "480-286-0455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JAE",
        "middle_name": "HYUN",
        "name_prefix": "Dr.",
        "credential": "DMD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "7019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Kay Park
• Andrew S Park, PHARMD
• Cleopatra C Park, N.P.
• Connor Charles Park
• Donald W Park, M.D.
• Jennifer Park, M.D.
• Jung K Park, M.D.
• Keun Hye Park
• Kwiok Gloria Park
• Michelle Hae-Min Park, DO

• Orthodontics and Dentofacial Orthopedics Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.