Individual
JIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
507 W STAN SCHLUETER LOOP STE 400, KILLEEN, TX 76542-6877
(254) 870-9209
Mailing address
1011 E 5TH ST APT 1447, AUSTIN, TX 78702-4065
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
39421
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/21/2016
Last updated
07/13/2023
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