Individual
JAE H PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3259 CATLIN AVE, QUANTICO, VA 22134-5109
(757) 953-9000
Mailing address
2701 NEABSCO COMMON PL APT 519, WOODBRIDGE, VA 22191-6717
(703) 254-8008
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401416211
VA
Other
Enumeration date
10/23/2018
Last updated
02/28/2023
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