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General NPI Number Information
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NPI Number | 1285935486
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Entity Type | Organization
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Legal Business Name | SANG H. PARK DENTAL CORP
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 10055 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1600
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Country | US
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Telephone | 714-638-4042
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Fax | 714-638-2141
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Provider Business Mailing Address
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Address Line | 10055 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1600
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Country | US
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Telephone | 714-638-4042
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Fax | 714-638-2141
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Authorized Official
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Title or Position | CFO
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Name | SANGHOON PARK
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Credential | DDS
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Telephone | 714-638-4042
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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 | #53583
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | #54608
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License Number State | CA
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