Provider Demographics
NPI:1336296508
Name:PARK, WON H (DDS)
Entity Type:Individual
Prefix:DR
First Name:WON
Middle Name:H
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 1:29700 RANCHO CALIFORNIA RD STE G5
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5293
Mailing Address - Country:US
Mailing Address - Phone:951-693-9595
Mailing Address - Fax:951-693-9696
Practice Address - Street 1:29700 RANCHO CALIFORNIA RD STE G5
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5293
Practice Address - Country:US
Practice Address - Phone:951-693-9595
Practice Address - Fax:951-693-9696
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice