# DR. NAM PARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1326293614
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 053029 | NY | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI02506200 | NJ | — |

## Other

- **Enumeration date:** 12/01/2008
- **Last updated:** 12/30/2020