Healthcare Provider Details

I. General information

NPI: 1598674400
Provider Name (Legal Business Name): ANDREW T.H. PARK, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 E ALLUVIAL AVE STE 102
FRESNO CA
93720-3856
US

IV. Provider business mailing address

1875 E ALLUVIAL AVE STE 102
FRESNO CA
93720-3856
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-0700
  • Fax: 559-325-0704
Mailing address:
  • Phone: 559-325-0700
  • Fax: 559-325-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TAE PARK
Title or Position: OWNER
Credential: DDS
Phone: 559-325-0700