Provider Demographics
NPI:1992584288
Name:JOHN J PARK LLC
Entity type:Organization
Organization Name:JOHN J PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOONTAE
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-348-3207
Mailing Address - Street 1:12421 SE VOYAGEURS LP
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-348-3207
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-284-2893
Practice Address - Fax:503-287-2016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN J PARK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty