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General NPI Number Information
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NPI Number | 1255227187
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Entity Type | Individual
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Provider Name | EUNSOO PARK DDS
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Gender | Female
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 4320 MILLS CIR STE B
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City | ONTARIO
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State | CA
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Zip | 91764-5246
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Country | US
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Telephone | 650-704-6843
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 S 5TH AVE UNIT 140
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City | MONROVIA
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State | CA
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Zip | 91016-3869
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Country | US
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Telephone | 510-909-8992
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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 | 111676
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License Number State | CA
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