Jonghan Park, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

18807 Issued in FL

Practice address

16605 E Palisades Blvd Ste 112
Fountain Hills, AZ 85268-3716

Phone

(480) 837-2000

Fax

(480) 837-2078

NPI assigned

Oct 5, 2009

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

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

• Arizona Dental Professionals, P.C.

  dba Sundome Crossing Dental Care

  • General Practice Dentistry
  • Sun City West, AZ
  • NPI 1851933857
  NPD (past)
• Arizona Dental Professionals, PC

  dba Fountain Hills Dental Care

  • General Practice Dentistry
  • Fountain Hills, AZ
  • NPI 1528259009
  NPD (past)
• DCP Az, LLC

  dba Stone Creek Dental Care

  • General Practice Dentistry
  • Chandler, AZ
  • NPI 1134206170
  NPD (past)
• Comfortable Care Dental Health Professionals, PA

  dba University Family Dentistry

  • General Practice Dentistry
  • Gainesville, FL
  • NPI 1861604530
  NPD (past)

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

{
    "created_epoch": "1254700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593129600000",
    "number": "1902131238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16605 E PALISADES BLVD STE 112",
            "city": "FOUNTAIN HILLS",
            "state": "AZ",
            "postal_code": "852683716",
            "telephone_number": "480-837-2000",
            "fax_number": "480-837-2078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16605 E PALISADES BLVD STE 112",
            "city": "FOUNTAIN HILLS",
            "state": "AZ",
            "postal_code": "852683716",
            "telephone_number": "480-837-2000",
            "fax_number": "480-837-2078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JONGHAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-05",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "18807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katy-Lynne Osborn, SCHOOL PSYCHOLOGIST
• Arwa Mohamed Osman
• Gary Alexander Osses, M.S. OTR/L
• Pain to Presence Psychotherapy LLC
• Palisades Family Chiropractic Wellness Center Inc
• Andrea Parra
• Shital Patel
• Abigail Rose Patinella, M.S. CCC-SLP
• Brian Paulsen, OTR/L
• Katie Shasha Paulsen

• Dentist in Fountain Hills, AZ
• Providers in Fountain Hills, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; 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.