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General NPI Number Information
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NPI Number | 1609559491
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Entity Type | Organization
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Legal Business Name | JAE HONG PARK DENTAL, P.C.
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 71 SCHOOL ST # 1010
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City | GLEN COVE
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State | NY
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Zip | 11542-2511
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Country | US
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Telephone | 347-509-4084
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Fax |
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Provider Business Mailing Address
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Address Line | 184 KENT AVE APT A304
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City | BROOKLYN
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State | NY
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Zip | 11249-3176
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Country | US
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Telephone | 929-888-5010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAE HONG PARK
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Credential | DMD
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Telephone | 929-888-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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