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General NPI Number Information
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NPI Number | 1003434499
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Entity Type | Individual
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Provider Name | WILLIAM K PARK DDS
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Gender | Male
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Dates
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Enumeration Date | 07/11/2020
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 26741 RANCHO PKWY STE 105-A
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City | LAKE FOREST
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State | CA
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Zip | 92630-8710
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Country | US
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Telephone | 949-716-4892
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Fax |
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Provider Business Mailing Address
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Address Line | 19969 AUBURN LN
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City | YORBA LINDA
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State | CA
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Zip | 92886-7961
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Country | US
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Telephone | 909-973-4964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 106661
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License Number State | CA
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