Provider Demographics
NPI:1336365790
Name:PAK, MARK JUNGWON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JUNGWON
Last Name:PAK
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 1:4148 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1552
Mailing Address - Country:US
Mailing Address - Phone:818-369-7790
Mailing Address - Fax:
Practice Address - Street 1:4148 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1552
Practice Address - Country:US
Practice Address - Phone:818-369-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499661223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice