MEDICARE: MYUNG KEE PARK DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255100020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYUNG KEE PARK DDS INC

Provider Business Mailing Address
First Line	:	14435 MORENO BEACH DR STE 108
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92555-8706
Country	:	US
Telephone Number	:	951-247-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	14435 MORENO BEACH DR STE 108
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92555-8706
Country	:	US
Telephone Number	:	951-247-6000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MYUNG KEE PARK
Credential	:	DDS
Telephone Number	:	951-247-6000

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	01/07/2026

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