Individual
DR. TAIJOON PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
101 2ND ST, LAKEWOOD, NJ 08701-3324
(732) 363-6655
Mailing address
101 2ND ST, LAKEWOOD, NJ 08701-3324
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02724700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22DI02724700
NEW JERSEY DENTAL LICENSE
NJ
Enumeration date
07/20/2018
Last updated
10/26/2018
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