Organization
JC PARK DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAECHAN PARK DDS (CEO)
(626) 454-0159
Entity
Organization
Contact information
Practice address
1505 S RIVERSIDE AVE UNIT B, RIALTO, CA 92376-7725
(909) 440-5345
Mailing address
15201 S WESTERN AVE, GARDENA, CA 90249-4314
(310) 400-7705
(310) 400-7714
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/22/2024
Last updated
03/22/2024
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