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General NPI Number Information
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NPI Number | 1295104453
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Entity Type | Individual
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Provider Name | CHLOE MIHYEONHAN PARK DDS
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Gender | Female
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 1687 HYACINTH AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4217
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Country | US
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Telephone | 909-645-1129
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Fax |
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Provider Business Mailing Address
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Address Line | 1687 HYACINTH AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4217
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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 |
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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 | DDS64557
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License Number State | CA
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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 | 64557
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License Number State | CA
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