Humboldt Community Dental PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

HUMBOLDT COMMUNITY DENTAL PC

Doing business as

Sonrisa Family Dental

Practice address

1044 N Mozart St
Suite 401
Chicago, IL 60622-2789

Phone

(773) 772-9200

Fax

(773) 772-9203

NPI assigned

Jul 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jason Korkus, DDS

Title

President

Phone

(773) 772-9200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sonrisa Family Dental Doing business as

Locations

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185321600000",
    "number": "1942490149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N MOZART ST",
            "address_2": "SUITE 401",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222789",
            "telephone_number": "773-772-9200",
            "fax_number": "773-772-9203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N MOZART ST",
            "address_2": "SUITE 401",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222789",
            "telephone_number": "773-772-9200",
            "fax_number": "773-772-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT COMMUNITY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2007-07-25",
        "status": "A",
        "authorized_official_last_name": "KORKUS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-772-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163914",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sonrisa Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wasay Humayun, M.D.
• Youshay Humayun, M.D.
• Michelle Humbert, LMSW
• Humberto Vergara MD & Associates SC
• Humboldt Behavioral Health Group
• Humboldt Park Counseling, PLLC
• Humboldt Park Counseling, PLLC
• Humboldt Park Counseling, PLLC
• Humboldt Park Counseling, PLLC (Rogers Park Counseling, PLLC)
• Humboldt Park Health

• Dental Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.