MEDICARE: DR. HYOGIN PARK DMD

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	1223G0001X	General Practice Dentistry	106750	CA

General Provider Information

NPI Number	:	1285256461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYOGIN PARK DMD

Provider Business Mailing Address
First Line	:	8552 WESTMINSTER BLVD
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8552 WESTMINSTER BLVD
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4605
Country	:	US
Telephone Number	:	714-379-1322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	07/29/2021

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