Provider Demographics
NPI:1447581186
Name:PARK, DANIEL JINSANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JINSANG
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 1:6777 WESTMINSTER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8057
Mailing Address - Country:US
Mailing Address - Phone:714-894-3151
Mailing Address - Fax:714-894-8685
Practice Address - Street 1:6777 WESTMINSTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-8057
Practice Address - Country:US
Practice Address - Phone:714-894-3151
Practice Address - Fax:714-894-8685
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist