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General NPI Number Information
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NPI Number | 1578088779
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Entity Type | Individual
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Provider Name | SUNG WOOK PARK DDS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/16/2020
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Provider Practice Location Address
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Address Line | 14930 IMPERIAL HWY STE D
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City | LA MIRADA
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State | CA
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Zip | 90638-2100
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Country | US
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Telephone | 562-777-1234
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Fax | 562-777-2345
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Provider Business Mailing Address
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Address Line | 80 MEANDER
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City | IRVINE
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State | CA
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Zip | 92620-7362
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Country | US
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Telephone | 909-553-3786
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 101539
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License Number State | CA
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