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General NPI Number Information
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NPI Number | 1558184903
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Entity Type | Organization
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Legal Business Name | HYUN JUN PARK DDS INC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3130 W OLYMPIC BLVD STE 320
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City | LOS ANGELES
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State | CA
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Zip | 90006-2494
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Country | US
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Telephone | 213-503-9470
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Fax |
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Provider Business Mailing Address
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Address Line | 4831 VANDERHAM WAY
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City | EASTVALE
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State | CA
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Zip | 91752-3926
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Country | US
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Telephone | 213-503-9470
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HYUN JUN PARK
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Credential | DDS
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Telephone | 213-503-9470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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