Provider Demographics
NPI:1154847234
Name:PARK, MYUNG KEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYUNG KEE
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 AYERS ROCK RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6044
Mailing Address - Country:US
Mailing Address - Phone:909-524-6119
Mailing Address - Fax:
Practice Address - Street 1:473 E ALESSANDRO BLVD # A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6021
Practice Address - Country:US
Practice Address - Phone:951-789-6886
Practice Address - Fax:951-780-1998
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist