Individual
CHANGSU PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D. D. S.
Contact information
Practice address
100 PRISON RD, REPRESA, CA 95671-0002
(916) 985-8610
Mailing address
PO BOX 290002, REPRESA, CA 95671-0002
(916) 985-8610
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
35532
CA
Other
Enumeration date
11/26/2007
Last updated
03/07/2016
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