| NPI | 1376114207 |
|---|---|
| Former Name | JU YOUNG PARK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122376) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002618-15) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.033440) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2024-08-01 |