Individual
JUNG MIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3420 BUFORD DR STE E780, BUFORD, GA 30519-8774
(678) 765-9930
Mailing address
2620 MOON CHASE LN, BUFORD, GA 30519-5363
(917) 683-1392
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015793
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2017
Last updated
06/24/2021
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