Individual
DR. IN KOOK PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1732 DEKALB PIKE, BLUE BELL, PA 19422-3352
(610) 278-1110
(610) 278-1852
Mailing address
1732 DEKALB PIKE, BLUE BELL, PA 19422-3352
(610) 278-1110
(610) 278-1852
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS035609
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101079572
—
PA
Enumeration date
11/20/2006
Last updated
10/18/2008
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