Provider Demographics
NPI:1003094426
Name:PARK, KYUNGSIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYUNGSIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 E ALESSANDRO BLVD
Mailing Address - Street 2:STE 7D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5083
Mailing Address - Country:US
Mailing Address - Phone:951-780-9800
Mailing Address - Fax:951-780-3267
Practice Address - Street 1:285 E ALESSANDRO BLVD
Practice Address - Street 2:STE 7D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5083
Practice Address - Country:US
Practice Address - Phone:951-780-9800
Practice Address - Fax:951-780-3267
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist