Provider Demographics
NPI:1457664070
Name:PARK, D.M.D., CORP.
Entity Type:Organization
Organization Name:PARK, D.M.D., CORP.
Other - Org Name:PARK, D.M.D., CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNGHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-542-5558
Mailing Address - Street 1:16709 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3244
Mailing Address - Country:US
Mailing Address - Phone:310-542-5558
Mailing Address - Fax:310-542-4309
Practice Address - Street 1:16709 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3244
Practice Address - Country:US
Practice Address - Phone:310-542-5558
Practice Address - Fax:310-542-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty