Provider Demographics
NPI:1134278948
Name:PARK, SUNGJIN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUNGJIN
Middle Name:JAMES
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 E BASTANCHURY RD
Mailing Address - Street 2:#191
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2786
Mailing Address - Country:US
Mailing Address - Phone:714-309-9390
Mailing Address - Fax:714-917-2077
Practice Address - Street 1:1038 E BASTANCHURY RD
Practice Address - Street 2:#191
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2786
Practice Address - Country:US
Practice Address - Phone:714-309-9390
Practice Address - Fax:714-917-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410301223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist