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Individual
JIN PARK
Active
Individual
JIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
39421
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D12135
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/21/2016
Last updated
07/14/2026
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