JAECHAN PARK D.D.S. NPI 1275666315

NPI Information

NPI: 1275666315
Provider Name: JAECHAN PARK, D.D.S.
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

PECOS Registration: Yes

Address:
2421 E TUDOR RD STE 101
ANCHORAGE, AK
ZIP 99507
Phone: (907) 222-6000
Get Directions

Jaechan Park, D.D.S. is a general practice dentist in Anchorage, AK. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. Jaechan Park, D.D.S. NPI is 1275666315. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2421 E TUDOR RD STE 101
ANCHORAGE, AK
ZIP 99507-166
Phone: (907) 222-6000
Fax: (907) 677-1247

The NPI 1275666315 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 3/14/2007 and was last updated on 5/14/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	49972	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	B49972-01	OTHER	CALIFORNIA	HEALTHY FAMILY
2	G92988-01	OTHER	CALIFORNIA	DENTICAL
3	1687022	OTHER	PENNSYLVANIA	UNITED CONCORDIA
4	1581480	MEDICAID	ALASKA
5	D49972	OTHER	CALIFORNIA	DENTICAL-RENDERING ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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