Provider Demographics
NPI:1457498230
Name:PARK, BIN HO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BIN
Middle Name:HO
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 1:378 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-2039
Mailing Address - Country:US
Mailing Address - Phone:951-735-7410
Mailing Address - Fax:951-735-9066
Practice Address - Street 1:378 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-2039
Practice Address - Country:US
Practice Address - Phone:951-735-7410
Practice Address - Fax:951-735-9066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42869-01Medicare ID - Type Unspecified