Provider Demographics
NPI:1841925724
Name:PARK, JOHN JONGCHEOL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JONGCHEOL
Last Name:PARK
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 1:819 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2045
Mailing Address - Country:US
Mailing Address - Phone:310-995-1783
Mailing Address - Fax:
Practice Address - Street 1:819 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2045
Practice Address - Country:US
Practice Address - Phone:310-995-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist