City Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CITY DENTAL LLC

Practice address

1100 Washington Ave 2ND Floor
Philadelphia, PA 19147

Phone

(215) 462-4877

Fax

(215) 462-4871

NPI assigned

Nov 20, 2018

Organization subpart

No

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

Authorized official

Name

Jae Chae, DMDNPI 1972798528

Title

Owner

Phone

(215) 462-4877

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jae Min Chae, DMD

  • General Practice Dentistry
  • Philadelphia, PA
  • NPI 1972798528
  NPD (past) Authorized official

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

{
    "created_epoch": "1542672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542672000000",
    "number": "1972072908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WASHINGTON AVE 2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19147",
            "telephone_number": "215-704-0056",
            "fax_number": "215-462-4871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WASHINGTON AVE 2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19147",
            "telephone_number": "215-462-4877",
            "fax_number": "215-462-4871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-20",
        "last_updated": "2018-11-20",
        "status": "A",
        "authorized_official_last_name": "CHAE",
        "authorized_official_first_name": "JAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-462-4877",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102705580",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Citrin, MD
• Lindsey E Citron, VMD
• Elizabeth Citrone
• City Chiropractic & Rehabilitation
• City Community Care
• City Line E.N.T., PC
• City Line Pediatrics
• City of Phila Trustee Acting by the BRD of Dir of City Trusts
• City of Philadelphia
• City of Philadelphia

• Dental Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dental Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; 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.