Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1275666315 Individual Practitioner Male Practitioner

Dr. Jaechan Park , DDS

Dentist - General Practice • Gardena, CA

Professional Overview & Biography Verified Profile Summary

Dr. Jaechan Park, DDS is a registered healthcare professional specializing in Dentist - General Practice in Gardena, CA. Practice services are available at 15201 S WESTERN AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

15201 S Western Ave

Gardena, CA 902494314

Telephone 3104007705
Associated Practice Facility / Clinic
🏢 Jc Park Dental Group, Inc. Facility NPI 1215638713

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Gardena, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 21.7 Yrs
Regional Practice Density
34 Specialists

Practicing in Gardena, CA (18734 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-03-13
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License CA 49972

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1581480 (AK)
Commercial Insurance / Payer ID United Concordia
1687022 (PA)
Commercial Insurance / Payer ID Dentical
G92988-01 (CA)
Commercial Insurance / Payer ID Healthy Family
B49972-01 (CA)
Commercial Insurance / Payer ID Dentical-Rendering Id
D49972 (CA)

Secondary Practice Locations

2421 E Tudor Rd Ste 101

Anchorage, AK 995071166

Phone: 9072226000

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Helen Park

Dentist - General Practice

NPI 1639090020

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location March 13, 2023

Registered at 15201 S WESTERN AVE, GARDENA, CA 902494314 (Tel: 3104007705)

📍
Updated Business Mailing Address March 13, 2023

Registered at 614 INVERNESS CT, FULLERTON, CA 928352776 (Tel: 6264540159)

NPI Profile Active May 14, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location May 14, 2014

Registered at 2421 E TUDOR RD STE 101, ANCHORAGE, AK 995071166 (Tel: 9072226000)

📍
Updated Business Mailing Address May 14, 2014

Registered at 2421 E TUDOR RD STE 101, ANCHORAGE, AK 995071166 (Tel: 9072226000)

👤
Provider Name / Credentials Updated May 14, 2014

Recorded as JAECHAN PARK, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 14, 2014

Dentist (License #49972 in CA)

🟢
Initial NPI Registration & Enumeration March 14, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1275666315
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 14, 2007
Last Update: March 13, 2023
Sole Proprietor: Yes

Mailing Address

614 Inverness Ct

Fullerton, CA 928352776

Phone: 6264540159

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.