Provider Demographics
NPI:1770763468
Name:SANGHOON PARK, DDS, INC.
Entity type:Organization
Organization Name:SANGHOON PARK, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-689-2200
Mailing Address - Street 1:13031 KERRY ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1638
Mailing Address - Country:US
Mailing Address - Phone:714-689-2200
Mailing Address - Fax:714-689-9112
Practice Address - Street 1:13031 KERRY ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1638
Practice Address - Country:US
Practice Address - Phone:714-689-2200
Practice Address - Fax:714-689-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54608261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD54608OtherMEDICAL ID
CAG8961601OtherMEDICAL PROVIDER ID