Jackson Jeong, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22DI02827600 Issued in NJ

Practice address

751 Teaneck Rd
Teaneck, NJ 07666-4242

Phone

(617) 834-0237

NPI assigned

Jun 22, 2017

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 MI

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 and National Provider Directory roles.

• Jackson Jeong DDS LLC

  • Pediatric Dentistry
  • Vernon, NJ
  • NPI 1184317729
  NPD Authorized official
• Pro Dental Mi 1 PC

  • General Practice Dentistry
  • Lansing, MI
  • NPI 1518794882
  NPD (past)

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1992225791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 GLEN AVE # A",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501806",
            "telephone_number": "617-834-0237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 TEANECK RD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664242",
            "telephone_number": "617-834-0237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEONG",
        "first_name": "JACKSON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-22",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02827600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah Jarvis, MS, RDN
• Jason Dean, MD LLC
• Jason'S Sensory Gym
• Steffy Jean-Baptiste, NP
• Hendy Bulter Jean, M.D.
• Jamie Jeong, PA
• Jewish Association for Developmental Disabilities
• Jewish Association for Developmental Disabilities
• Jewish Association for Developmental Disabilities
• Jewish Association for Developmental Disabilities

• Pediatric Dentistry in Teaneck, NJ
• Providers in Teaneck, NJ by specialty
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.