MEDICARE: DR. JOSEPH WON-JOON PARK D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	3613	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205813227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WON-JOON PARK D.M.D

Provider Business Mailing Address
First Line	:	1755 SAINT JULIAN PL
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2409
Country	:	US
Telephone Number	:	803-254-2972
Fax Number	:	803-799-2151

Provider Business Practice Location Address
First Line	:	1755 SAINT JULIAN PL
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2409
Country	:	US
Telephone Number	:	803-254-2972
Fax Number	:	803-799-2151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. JOSEPH WON-JOON PARK D.M.D” Practice Location

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