Provider Demographics
NPI:1255227187
Name:PARK, EUNSOO (DDS)
Entity type:Individual
Prefix:
First Name:EUNSOO
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 1:1110 S 5TH AVE UNIT 140
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3869
Mailing Address - Country:US
Mailing Address - Phone:510-909-8992
Mailing Address - Fax:
Practice Address - Street 1:4320 MILLS CIR STE B
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5246
Practice Address - Country:US
Practice Address - Phone:650-704-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist