JI WON PARK (NPI# 1255984324) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255984324 |
| Entity Type | Individual |
| Full Name | JI WON PARK |
| Credential | DMD |
| Practice Address |
1605 Roberta Dr Sw Marietta GA 30008-3855 |
| Mailing Address |
11 Perimeter Ctr E Apt 2304 Atlanta GA 30346-1650 |
| Practice Telephone | 7704193120 |
| Mailing Telephone | 4044284851 |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2019-07-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN015875 | GA | Dental Providers |
| Street Address |
1605 ROBERTA DR SW |
| City | MARIETTA |
| State | GA |
| Zip Code | 30008-3855 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710063680 | Peter Wyman | Internal Medicine | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2006-10-31 |
| 1275015281 | Venetta Diale Belowe Mwengella | Nurse Practitioner | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2018-09-06 |
| 1922503572 | Patricia Guzman | Dental Hygienist | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2018-03-27 |
| 1912458456 | Joel Philip Carpenter | Family Medicine | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2016-10-19 |
| 1578819918 | Laura L. Bayani | Physician Assistant | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2012-08-02 |
| 1659650331 | Alan B Kirk | Social Worker | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2011-08-11 |
| 1326349614 | Marjan Zarif Kirkland | Nurse Practitioner | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2010-11-03 |
| 1881923126 | Good Samaritan Health Center of Cobb | Voluntary or Charitable | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2009-12-16 |
| 1669609442 | Dolly Penn White | Preventive Medicine | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2009-06-18 |
| 1740454875 | Adrienne Nicole Polite | Family Medicine | 1605 Roberta Dr Sw, Marietta, GA 30008-3855 | 2008-04-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952740276 | Beta Discount Pharmacy & Health Services, LLC | Pharmacy | 776 Sandtown Rd Sw, Marietta, GA 30008 | 2013-06-19 |
| 1982935607 | Family Home Care, LLC | Respite Care | 1791 Silver Leaf Ct, Marietta, GA 30008 | 2010-01-20 |
| 1952546533 | Daniel Park | Plastic Surgery | 2285 Asquith Ave Sw Ste 200, Marietta, GA 30008 | 2008-12-10 |
| 1265657399 | Scott D Warner | Chiropractor | 3201 Austell Rd Sw, Marietta, GA 30008 | 2007-04-16 |
| 1972572642 | Cobb County Board of Health | Public Health or Welfare | 1650 County Services Parkway, Marietta, GA 30008 | 2006-03-15 |
| 1538662622 | Lorna Brown | Nurse Practitioner | 1825 County Services Pkwy Sw, Marietta, GA 30008 | 2018-03-14 |
| 1760825905 | Avantika Varma | Family Medicine | 1650 County Services Pkwy Sw Ste 200, Marietta, GA 30008 | 2013-04-08 |
| 1689887663 | Brenda W Wilson | Psychiatry & Neurology | 1650 County Services Pkwy, Marietta, GA 30008 | 2007-05-07 |
| 1043423023 | Karen J Carter | Psychiatry & Neurology | 1650 County Services Pkwy, Marietta, GA 30008 | 2007-05-07 |
| 1043587330 | Francine Edwards | Speech-Language Pathologist | 3665 Austell Road Sw, Suite 1017, Marietta, GA 30008-0000 | 2011-11-30 |
| Find all providers in zip 30008 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427659028 | My Emergency Dental Ga, LLC | Dentist | 4811 Lower Roswell Rd Ste 108, Marietta, GA 30068-4345 | 2020-11-02 |
| 1811536212 | Sandy Plains Dental Group, PC | Dentist | 3460 Sandy Plains Rd, Suite 240, Marietta, GA 30062 | 2020-01-02 |
| 1104381359 | Castiblanco Dental Care LLC | Dentist | 3901 Roswell Rd Ste 220, Marietta, GA 30062-8816 | 2019-02-01 |
| 1982102653 | Superior Dental of East Cobb, LLC | Dentist | 2745 Sandy Plains Rd Ste 118, Marietta, GA 30066-4327 | 2018-01-29 |
| 1477068823 | Gina Dental LLC | Dentist | 1000 Johnson Ferry Rd Ste E125, Marietta, GA 30068-2100 | 2017-12-07 |
| 1669994109 | Boban Fidanoski | Dentist | 1150 Whitlock Ave Nw, Marietta, GA 30064-1933 | 2017-07-15 |
| 1245760859 | Michael H Mulkey, Dmd PC | Dentist | 3951 Mary Eliza Trace Nw, Suite 200, Marietta, GA 30064 | 2017-06-15 |
| 1659724532 | Neha Chakravarti | Dentist | 2230 Roswell Rd Ste 200, Marietta, GA 30062-2945 | 2016-07-15 |
| 1104218361 | Georgia Dental Professionals, PC | Dentist | 3052 Shallowford Rd Ste 100, Marietta, GA 30062-1252 | 2015-02-25 |
| 1124429212 | Family Tree Dental D Austin Rehl Dds and Peter E Lovejoy Dds LLC | Dentist | 30 Acme St, Marietta, OH 45750-3306 | 2014-09-09 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.