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General NPI Number Information
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NPI Number | 1366238990
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Entity Type | Individual
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Provider Name | JUMEE PARK DDS
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Gender | Female
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 2816 S 4TH AVE STE C
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City | YUMA
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State | AZ
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Zip | 85364-8101
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Country | US
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Telephone | 928-726-6023
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Fax |
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Provider Business Mailing Address
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Address Line | 114 E 5TH AVE APT 527
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City | COLUMBUS
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State | OH
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Zip | 43201-4479
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Country | US
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Telephone | 380-223-7431
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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 | D012529
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License Number State | AZ
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