Provider Demographics
NPI:1093183410
Name:GENE H PARK DDS, INC
Entity Type:Organization
Organization Name:GENE H PARK DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-530-1948
Mailing Address - Street 1:9240 GARDEN GROVE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1400
Mailing Address - Country:US
Mailing Address - Phone:714-530-1948
Mailing Address - Fax:714-530-1186
Practice Address - Street 1:9240 GARDEN GROVE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1400
Practice Address - Country:US
Practice Address - Phone:714-530-1948
Practice Address - Fax:714-530-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49631261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental