Provider Demographics
NPI:1841744638
Name:PARK, CHERYL JONGHEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:JONGHEE
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W. 34TH STREET, ROOM 4363
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089
Mailing Address - Country:US
Mailing Address - Phone:213-740-3612
Mailing Address - Fax:
Practice Address - Street 1:925 W. 34TH STREET, ROOM 4363
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089
Practice Address - Country:US
Practice Address - Phone:213-740-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624611223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics