| NPI | 1649651506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HANGSOO MICHAEL PARK Pediatric Dental Resident 224-595-9132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-06-26 |