Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Individual
JAECHAN PARK
Active
Individual
JAECHAN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49972
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1581480
—
AK
01
—
1687022
UNITED CONCORDIA
PA
01
—
B49972-01
HEALTHY FAMILY
CA
01
—
D49972
DENTICAL-RENDERING ID
CA
01
—
G92988-01
DENTICAL
CA
Enumeration date
03/14/2007
Last updated
03/13/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up