NPIMap

Individual provider Active NPI

Jeanette Genkyung Park, RDH

  • Dental Hygienist
  • Banning, CA
National Provider Identifier
1942557962
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
23312 Issued in CA
Practice address
6350 W Ramsey St
Suite a
Banning, CA 92220-3062
Phone
(951) 769-0466
Fax
(951) 769-3606
NPI assigned
Aug 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 23312 CA Primary

Addresses

Primary practice location

6350 W Ramsey St
Suite a
Banning, CA 92220-3062

Mailing address

6350 W Ramsey St
Suite a
Banning, CA 92220-3062
Phone (951) 769-0466

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Stanley Miller DDS, Professional Corporation Past Accepting new patients
Dr. Ohannessian Dental Corp Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1942557962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 W RAMSEY ST",
            "address_2": "SUITE A",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203062",
            "telephone_number": "951-769-0466",
            "fax_number": "951-769-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6350 W RAMSEY ST",
            "address_2": "SUITE A",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203062",
            "telephone_number": "951-769-0466",
            "fax_number": "951-769-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JEANETTE",
        "middle_name": "GENKYUNG",
        "name_prefix": "Mrs.",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-08",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "23312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Banning, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; 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.