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General NPI Number Information
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NPI Number | 1700630035
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Entity Type | Individual
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Provider Name | MOHYUN PARK
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Gender | Male
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Dates
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Enumeration Date | 04/15/2024
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 1537 HOWE AVE STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95825-3360
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Country | US
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Telephone | 279-499-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 3485 MONROE ST APT 309
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City | SANTA CLARA
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State | CA
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Zip | 95051-7722
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Country | US
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Telephone | 408-592-4940
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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 | DN123423
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS111721
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License Number State | CA
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