Provider Demographics
NPI:1578688495
Name:PARK, YONG EON (DDS)
Entity Type:Individual
Prefix:DR
First Name:YONG EON
Middle Name:
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 1:1120 CALLOWAY DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6398
Mailing Address - Country:US
Mailing Address - Phone:661-588-2772
Mailing Address - Fax:661-588-3773
Practice Address - Street 1:1120 CALLOWAY DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6398
Practice Address - Country:US
Practice Address - Phone:661-588-2772
Practice Address - Fax:661-588-3773
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice