Provider Demographics
NPI:1942200050
Name:PARK, CHUNG-JAE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHUNG-JAE
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21035 SW PACIFIC HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8036
Mailing Address - Country:US
Mailing Address - Phone:503-575-4864
Mailing Address - Fax:503-966-3993
Practice Address - Street 1:21035 SW PACIFIC COAST HWY
Practice Address - Street 2:STE 100
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-925-1473
Practice Address - Fax:503-925-1479
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist