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General NPI Number Information
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NPI Number | 1740406784
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Entity Type | Organization
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Legal Business Name | SANG C PAIK DDS
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11201 SIERRA AVE SUITE 1F
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City | FORTANA
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State | CA
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Zip | 92337
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Country | US
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Telephone | 909-355-3299
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Fax | 951-355-3944
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Provider Business Mailing Address
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Address Line | 11201 SIERRA AVE SUITE 1F
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City | FORTANA
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State | CA
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Zip | 92337
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Country | US
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Telephone | 909-355-3299
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Fax | 951-355-3944
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | SANG CHURL PAIK
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Credential | DDS
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Telephone | 909-355-3299
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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 | 41861
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License Number State | CA
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