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General NPI Number Information
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NPI Number | 1285308841
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Entity Type | Organization
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Legal Business Name | JAEIN PARK DDS INC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 2048 ORANGE TREE LN STE 100
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City | REDLANDS
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State | CA
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Zip | 92374-4566
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Country | US
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Telephone | 909-953-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 25519 CARROL CT
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City | LOMA LINDA
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State | CA
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Zip | 92354-3700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | JAEIN PARK
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Credential | DDS
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Telephone | 909-593-5140
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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 |
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License Number State |
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