Jin Woo Park, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

29792 Issued in TX

Practice address

1607 W Henderson St Ste K
Cleburne, TX 76033-4179

Phone

(817) 522-3166

Fax

(817) 522-3168

NPI assigned

Jul 13, 2010

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 TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cleburne Dental Studio PLLC

  • General Practice Dentistry
  • Cleburne, TX
  • NPI 1952824468
  NPD Authorized official
• Great Smiles PLLC

  • General Practice Dentistry
  • Garland, TX
  • NPI 1215603105
  NPD Authorized official

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1992017461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 W HENDERSON ST STE #K",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "76033",
            "telephone_number": "817-522-3166",
            "fax_number": "817-522-3168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 W HENDERSON ST STE K",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760334179",
            "telephone_number": "817-522-3166",
            "fax_number": "817-522-3168"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 Harmony Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Grapevine",
            "state": "TX",
            "postal_code": "760511134",
            "country_code": "US",
            "telephone_number": "267-210-2725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "126 N International Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Garland",
            "state": "TX",
            "postal_code": "750426515",
            "country_code": "US",
            "telephone_number": "972-272-7944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JIN",
        "middle_name": "WOO",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-13",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "29792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanne Snowden Odle, PT
• Babatunde Enoch Oladimeji, PLMHP
• Yevgeniy Ostrinsky, MD
• Cheyenne Lakota Pagel, FNP-C
• Jake Park, DDS
• Kristine Parkinson
• Heather D Parks
• Kyle T Parrish, DPT
• Radha Pasala, MD
• Nishani Rasik Patel, OD

• Dentist in Cleburne, TX
• Providers in Cleburne, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; 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.