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General NPI Number Information
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NPI Number | 1033257233
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Entity Type | Individual
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Provider Name | WONPYO ERIC PARK D.D.S
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 11851 SOUTH ST
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City | CERRITOS
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State | CA
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Zip | 90703-6825
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Country | US
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Telephone | 562-809-8911
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 AVENIDA DEL NORTE
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City | FULLERTON
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State | CA
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Zip | 92833-1820
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Country | US
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Telephone | 714-656-6645
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00010771
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4956T
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56613
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License Number State | CA
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