| NPI | 1184834996 |
|---|---|
| Former Name | JACQUELINE SUNJA PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019031964) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 16294) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-02-13 |