NPI 1013581677

Jay Park, DMD

Practitioner General Practice Dentistry Auburn, WA

Practice location

Address: 1404 Lake Tapps Pkwy SE STE A103, Auburn, WA 98092-8156
Phone: (253) 341-4973
Mailing address: 12319 41st Street CT E, Edgewood, WA 98372-7801

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence DE61164036 (WA)

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Registry record

NPI: 1013581677
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 May 2021
Record last updated: 18 May 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.