John J Park LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JOHN J PARK LLC

Practice address

2100 NE Broadway St
Portland, OR 97232

Phone

(503) 284-2893

Fax

(503) 287-2016

NPI assigned

Sep 26, 2023

Organization subpart

Yes

Parent organization

JOHN J PARK LLCAs reported in NPPES

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

Authorized official

Name

John Joontae Park, DDS

Title

Dentist, Owner

Phone

(503) 348-3207

Specialties & licenses 1

Addresses

Other names 1

• NE Portland Dental Doing business as

Part of

John J Park LLC

Locations

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

{
    "created_epoch": "1695686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1992584288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12421 SE VOYAGEURS LP",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "97086",
            "telephone_number": "503-348-3207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97232",
            "telephone_number": "503-284-2893",
            "fax_number": "503-287-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN J PARK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN J PARK LLC",
        "enumeration_date": "2023-09-26",
        "last_updated": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JOONTAE",
        "authorized_official_title_or_position": "DENTIST, OWNER",
        "authorized_official_telephone_number": "503-348-3207",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NE Portland Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.