JAECHAN PARK D.D.S. NPI 1275666315

NPI Information

  • NPI: 1275666315
  • Provider Name: JAECHAN PARK, D.D.S.
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 15201 S WESTERN AVE
    GARDENA, CA
    ZIP 90249
  • Phone: (310) 400-7705

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NPI Details

Jaechan Park, D.D.S. is a general practice dentist in Gardena, CA. 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:

15201 S WESTERN AVE
GARDENA, CA
ZIP 90249-314
Phone: (310) 400-7705

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 3/13/2023.

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
11223G0001XDentistGeneral Practice49972CALIFORNIAYes

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
11687022OTHERPENNSYLVANIAUNITED CONCORDIA
2G92988-01OTHERCALIFORNIADENTICAL
31581480MEDICAIDALASKA
4B49972-01OTHERCALIFORNIAHEALTHY FAMILY
5D49972OTHERCALIFORNIADENTICAL-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: 3/30/2025

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