Park, Jintae
Park, Jintae is an individual health care provider with primary practice located at 6795 S Virginia St E, Reno NV 89511-1171. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Park, Jintae can be contacted via phone (775) 853-0503.Contact Information
Primary practice address
6795 S Virginia St E
Reno NV 89511-1171
Phone: (775) 853-0503
Fax: (775) 853-0504
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 54686 | California |
| Dental Providers / Dentist | 122300000X | 5678 | Nevada |
Profile Details
| NPI number | 1629110747 |
|---|---|
| LBN Legal business name | Park, Jintae |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 13th, 2007 |
| Last updated | Jan 9th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629110747 | NPPES |
| California | MEDICAID | D54686 |
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