Healthcare Provider Details

I. General information

NPI: 1952227563
Provider Name (Legal Business Name): JACK Y PAI DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 NEWPORT AVE STE A
TUSTIN CA
92780-3745
US

IV. Provider business mailing address

13420 NEWPORT AVE STE A
TUSTIN CA
92780-3745
US

V. Phone/Fax

Practice location:
  • Phone: 626-779-6826
  • Fax:
Mailing address:
  • Phone: 626-779-6826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACK PAI
Title or Position: OWNER
Credential: DDS
Phone: 626-757-9906