MEDICARE: DR. JOOYOEL PARK

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	122300000X	Dentist	55530	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306979638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOOYOEL PARK

Provider Business Mailing Address
First Line	:	256 S HOBART BLVD
Second Line	:	APT #10
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-5248
Country	:	US
Telephone Number	:	760-969-5469
Fax Number	:	714-571-3560

Provider Business Practice Location Address
First Line	:	69160 RAMON RD.
Second Line	:	SUITE #100
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3343
Country	:	US
Telephone Number	:	760-969-5469
Fax Number	:	760-770-0280

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/09/2007

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Directions to “ DR. JOOYOEL PARK ” Practice Location

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