Individual
JAY SUNGJAE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(415) 489-0499
Mailing address
1959 NE PACIFIC STREET BOX 357134, SEATTLE, WA 98195-0001
(415) 489-0499
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DR61425062
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/23/2023
Last updated
07/01/2023
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