Healthcare Provider Details

I. General information

NPI: 1609926849
Provider Name (Legal Business Name): HYUNJUNG HOLLY PARK, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 TALL OAK
IRVINE CA
92603-0662
US

IV. Provider business mailing address

331 TALL OAK
IRVINE CA
92603
US

V. Phone/Fax

Practice location:
  • Phone: 714-357-9333
  • Fax:
Mailing address:
  • Phone: 714-357-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number54476
License Number StateCA

VIII. Authorized Official

Name: DR. HOLLY H PARK-NAH
Title or Position: CEO SECRETARY CFO
Credential: D.D.S.
Phone: 714-357-9333