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Dr. Jun Sup Park, DDS

Dentist in Downey, CA. Individual provider (NPI-1).

NPI number1669907663
StatusActive
Last updated in NPPESAug 19, 2022

Details

NPI
1669907663
Entity type
Individual (NPI-1)
Name
Dr. Jun Sup Park
Credential
DDS
Sex
Male
Sole proprietor
No
Enumeration date
Apr 27, 2017
Certification date
Aug 17, 2022
Last updated
Aug 19, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist107810CAYes
122300000X Dentist2901022211MI

Practice location

8612 Firestone Blvd
Downey, CA 90241-5243

Phone 562-382-1528

Mailing address

8612 Firestone Blvd
Downey, CA 90241-5243

Phone 562-382-1528

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