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General NPI Number Information
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NPI Number | 1033940374
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Entity Type | Individual
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Provider Name | PAUL JAHNG PARK DDS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 2560 MONTESSOURI ST STE 109
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City | LAS VEGAS
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State | NV
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Zip | 89117-3063
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Country | US
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Telephone | 702-362-9353
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Fax |
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Provider Business Mailing Address
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Address Line | 3185 S SEPULVEDA BLVD APT 101
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City | LOS ANGELES
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State | CA
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Zip | 90034-4221
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Country | US
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Telephone | 424-402-2933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8119
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License Number State | NV
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