# DR. JINTAE PARK

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

## Provider details

- **NPI number:** 1629110747
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 54686 | CA | — |
| 122300000X | Dentist | 5678 | NV | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 01/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | D54686 | — | CA |