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General NPI Number Information
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NPI Number | 1306460670
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Entity Type | Individual
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Provider Name | HAHNNAH PARK DDS
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 510 W RANCHO VISTA BLVD
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City | PALMDALE
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State | CA
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Zip | 93551-3737
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Country | US
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Telephone | 661-202-3052
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Fax |
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Provider Business Mailing Address
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Address Line | 37325 PAINTBRUSH DR
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City | PALMDALE
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State | CA
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Zip | 93551-6173
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Country | US
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Telephone | 609-864-4487
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | LL-542-20
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DDS108685
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License Number State | CA
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