Provider Demographics
NPI:1801338868
Name:D SANGHO PARK DDS INC
Entity type:Organization
Organization Name:D SANGHO PARK DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-403-1117
Mailing Address - Street 1:9375 SAN FERNANDO RD
Mailing Address - Street 2:6 TH FLOOR
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1418
Mailing Address - Country:US
Mailing Address - Phone:818-394-9686
Mailing Address - Fax:818-394-9637
Practice Address - Street 1:9375 SAN FERNANDO RD
Practice Address - Street 2:6 TH FLOOR
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1418
Practice Address - Country:US
Practice Address - Phone:818-394-9686
Practice Address - Fax:818-394-9637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53274Medicaid