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General NPI Number Information
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NPI Number | 1902056930
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Entity Type | Organization
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Legal Business Name | SANGHO PARK DENTAL INC
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 603 WAKE AVE SUITE #3
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City | EL CENTRO
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State | CA
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Zip | 92243-7500
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Country | US
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Telephone | 516-776-0449
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Fax | 760-353-4887
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Provider Business Mailing Address
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Address Line | 699 WAKE AVE #63
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City | EL CENTRO
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State | CA
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Zip | 92243-9598
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Country | US
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Telephone | 516-776-0449
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Fax | 760-353-4887
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Authorized Official
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Title or Position | CEO
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Name | SANGHO PARK
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Credential |
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Telephone | 516-776-0449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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