| Organization Name: | TAE EEN PARK,D.D.S.,INC |
| NPI Number: | 1063889558 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAE EEN PARK (CEO) |
| Mailing Address: | 190 S Oak Ave Ste 6 Oakdale |
| State: | CA US |
| Postal Code: | 953613528 |
| Phone Number: | 2098472800 |
| Fax Number: | 2098472929 |
| NPI Enumeration Date: | 08/31/2015 |
| NPI Last Update Date: | 08/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 56889 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |