Provider Demographics
NPI:1780734558
Name:PARK, JUN HAE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JUN HAE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 S SEPULVEDA BLVD STE 1110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3819
Mailing Address - Country:US
Mailing Address - Phone:210-846-0411
Mailing Address - Fax:
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 1110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3819
Practice Address - Country:US
Practice Address - Phone:310-338-9499
Practice Address - Fax:310-338-9508
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics