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Organization
KIM & PARK A DENTAL CORPORATION
Active
Organization
KIM & PARK A DENTAL CORPORATION
Active
Other names
moreno dental care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES C PARK DDS (PRESIDENT)
(951) 656-0088
Entity
Organization
Contact information
Practice address
23750 ALESSANDRO BLVD, SUITE O-102, MORENO VALLEY, CA 92553-8811
(951) 656-0088
(951) 656-0034
Mailing address
23750 ALESSANDRO BLVD, SUITE O-102, MORENO VALLEY, CA 92553-8811
(951) 656-0088
(951) 656-0034
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
50087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G89861-01
DENTI-CAL
CA
Enumeration date
08/29/2007
Last updated
08/29/2007
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