Provider Demographics
NPI:1669478871
Name:PARK, SANG HYUK (DDS)
Entity Type:Individual
Prefix:
First Name:SANG HYUK
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 1:6383 PINE MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2543
Mailing Address - Country:US
Mailing Address - Phone:415-867-1603
Mailing Address - Fax:
Practice Address - Street 1:3040 PARK AVE
Practice Address - Street 2:STE H
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3405
Practice Address - Country:US
Practice Address - Phone:209-722-7789
Practice Address - Fax:209-722-7811
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist