Ji Eun Park, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

054533 Issued in NY

Practice address

25-37 Broadway
Astoria, NY 11106

Phone

(718) 786-2631

NPI assigned

Aug 16, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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.

• Joy Dental, PLLC

  • General Practice Dentistry
  • Astoria, NY
  • NPI 1659626877
  NPD (past) Authorized official
• Dental Health of Astoria,PC

  • General Practice Dentistry
  • Astoria, NY
  • NPI 1093850133
  NPD (past)

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

{
    "created_epoch": "1250380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410480000000",
    "number": "1861624405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25-37 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "11106",
            "telephone_number": "718-786-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25-37 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "11106",
            "telephone_number": "718-786-2631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JI",
        "middle_name": "EUN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-16",
        "last_updated": "2014-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "054533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03142927",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hana Marie Pappas, NP
• Vasilios Pappas, DPT
• Shaina Parambil
• Lilly-Rose Paraskevas, MD
• Perri B. Pardini, R.N..
• Jiyeon Park
• Joon Park, M.D.
• Key H Park, LCAT
• Ryan Jungsun Park
• Won Hui Park, ACUPUNCTURIST

• Dentist in Astoria, NY
• Providers in Astoria, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; 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.