Provider Demographics
NPI:1003945775
Name:PARK, NANHEE (DDS)
Entity Type:Individual
Prefix:
First Name:NANHEE
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 1:6009 PENTZ RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5542
Mailing Address - Country:US
Mailing Address - Phone:530-876-3128
Mailing Address - Fax:530-876-7125
Practice Address - Street 1:6009 PENTZ RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5542
Practice Address - Country:US
Practice Address - Phone:530-876-3128
Practice Address - Fax:530-876-7125
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP7098660OtherDEA #
CABP7098660OtherDEA #