Provider Demographics
NPI:1922293398
Name:PARK, BOJUN (DDS)
Entity Type:Individual
Prefix:
First Name:BOJUN
Middle Name:
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 1:10337 ANTIGUA CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6360
Mailing Address - Country:US
Mailing Address - Phone:714-887-3397
Mailing Address - Fax:
Practice Address - Street 1:1112 S. BRISTOL ST.
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-668-9884
Practice Address - Fax:714-668-0381
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist