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General NPI Number Information
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NPI Number | 1942200050
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Entity Type | Individual
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Provider Name | CHUNG-JAE PARK DDS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 21035 SW PACIFIC COAST HWY STE 100
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City | SHERWOOD
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State | OR
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Zip | 97140
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Country | US
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Telephone | 503-925-1473
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Fax | 503-925-1479
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Provider Business Mailing Address
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Address Line | 21035 SW PACIFIC HWY STE 100
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City | SHERWOOD
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State | OR
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Zip | 97140-8036
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Country | US
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Telephone | 503-575-4864
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Fax | 503-966-3993
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D8095
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License Number State | OR
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