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General NPI Number Information
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NPI Number | 1669797296
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Entity Type | Organization
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Legal Business Name | WON BO PARK DDS APC
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | 1105 S. EUCLID ST. SUITE E
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City | FULLERTON
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State | CA
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Zip | 92832
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Country | US
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Telephone | 714-738-0304
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Fax | 213-380-2419
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Provider Business Mailing Address
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Address Line | 1105 S. EUCLID ST. SUITE E
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City | FULLERTON
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State | CA
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Zip | 92832
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Country | US
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Telephone | 714-738-0304
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Fax | 213-380-2419
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JOYCE YUNSUK PARK
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Credential |
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Telephone | 909-263-7768
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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 | 40048
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License Number State | CA
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