Individual
JIMMY SHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2455 ROUTE 516 FL 1, OLD BRIDGE, NJ 08857-1892
(646) 203-6960
Mailing address
8 FLORAL TERRACE, TENAFLY, NJ 07670
(646) 203-6960
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22DI02796200
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/31/2018
Last updated
05/17/2021
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