Provider Demographics
NPI:1346444684
Name:PARK, CHOON SUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHOON
Middle Name:SUNG
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 1:5329 OFFICE CENTER CT STE 105
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7400
Mailing Address - Country:US
Mailing Address - Phone:661-864-1364
Mailing Address - Fax:661-864-1561
Practice Address - Street 1:5329 OFFICE CENTER CT STE 105
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7400
Practice Address - Country:US
Practice Address - Phone:661-864-1364
Practice Address - Fax:661-864-1561
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice