Individual
DR. JAE SUNG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1578 CONSTITUTION BLVD, SUITE 01, ROCK HILL, SC 29732-3543
(803) 366-1456
(803) 324-0117
Mailing address
1578 CONSTITUTION BLVD, SUITE 01, ROCK HILL, SC 29732-3543
(803) 366-1456
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.8288 GD
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8288
—
SC
Enumeration date
08/06/2013
Last updated
12/24/2020
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