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NPI Code Detail

MEDICARE: GYU TAE PARK D.D.S.

MEDICARE: GYU TAE PARK D.D.S.
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
11223E0200XEndodontics27541NJ

General Provider Information

NPI Number : 1528451937
Entity Type Code : Individual
Provider Name (Legal Business Name) : GYU TAE PARK D.D.S.
Provider Business Mailing Address
First Line : 846 BERGEN AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07306-4404
Country : US
Telephone Number : 201-946-1000
Fax Number : 201-946-1641
Provider Business Practice Location Address
First Line : 846 BERGEN AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07306-4404
Country : US
Telephone Number : 201-946-1000
Fax Number : 201-946-1641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2015
Last Update Date : 09/30/2019

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