Jack Jaekoo Huh

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4284 Issued in AZ

Practice address

7802 N 43Rd Ave Ste 8
Baptist Dental Center
Glendale, AZ 85301-8111

Phone

(623) 939-6215

Fax

(623) 915-0654

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

Yes

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

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Baptist Dental Center, Inc.

  • General Practice Dentistry
  • Glendale, AZ
  • NPI 1073919452
  NPD (past) Authorized official

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1861483349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7802 N 43RD AVE STE 8",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853018111",
            "telephone_number": "623-939-6215",
            "fax_number": "623-915-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7802 N 43RD AVE STE 8",
            "address_2": "BAPTIST DENTAL CENTER",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853018111",
            "telephone_number": "623-939-6215",
            "fax_number": "623-915-0654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8501 N 51st Ave",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853024919",
            "country_code": "US",
            "telephone_number": "623-939-6215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUH",
        "first_name": "JACK",
        "middle_name": "JAEKOO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "4284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nattasha V. Huffaker, PA-C
• Cameron Scott Hughes, RBT
• Mark Brian Hughes, DDS
• Phyllis Anne Hughes, PLN
• Ellen Diane Hughson-Hale, CCC-SLP
• Heather A Huiting, LCSW
• Aaron Michael Hull, LMT
• Angelina Hull, LMT
• Craig R Hullett, M.D.
• Deijuna Hulsey

• General Practice Dentistry in Glendale, AZ
• Providers in Glendale, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.