Individual
DR. JAEHAN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
122 AMITY RD, NEW HAVEN, CT 06515-1405
(404) 403-5321
Mailing address
44 WASHINGTON ST APT A308, BROOKLINE, MA 02445-7130
(404) 403-5321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13552
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/22/2022
Last updated
08/25/2022
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