Provider Demographics
NPI:1619518321
Name:PARK, JUNSUK (DDS)
Entity Type:Individual
Prefix:
First Name:JUNSUK
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 1:11070 HIRSCHFELD WAY APT 50
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5260
Mailing Address - Country:US
Mailing Address - Phone:209-426-1693
Mailing Address - Fax:
Practice Address - Street 1:10910 OLSON DR STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5663
Practice Address - Country:US
Practice Address - Phone:714-845-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist