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General NPI Number Information
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NPI Number | 1457664070
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Entity Type | Organization
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Legal Business Name | PARK, D.M.D., CORP.
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Dates
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Enumeration Date | 07/24/2010
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Last Update Date | 07/24/2010
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Provider Practice Location Address
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Address Line | 16709 HAWTHORNE BLVD
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City | LAWNDALE
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State | CA
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Zip | 90260-3244
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Country | US
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Telephone | 310-542-5558
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Fax | 310-542-4309
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Provider Business Mailing Address
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Address Line | 16709 HAWTHORNE BLVD
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City | LAWNDALE
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State | CA
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Zip | 90260-3244
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Country | US
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Telephone | 310-542-5558
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Fax | 310-542-4309
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SUNGHAE PARK
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Credential | DMD
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Telephone | 310-542-5558
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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 | 57834
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License Number State | CA
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