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Jaechan Park, DDS
General Practice Dentistry in Gardena, California
NPI 1275666315

Jaechan Park is a General Practice Dentistry based in Fullerton, CA and is specialized in General Practice. Jaechan Park practices in Gardena, CA and has the professional credentials of DDS. The NPI Number for Jaechan Park is 1275666315 and holds a License No. 49972 (California).

The current practice location address for Jaechan Park is 15201 S Western Ave, Gardena, CA and can be reached out via phone at 310-400-7705.

Location: 15201 S Western Ave, Gardena, CA, 92835-2776
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1275666315
Provider Name
Jaechan Park
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
15201 S Western Ave, Gardena, CA, 92835-2776
Phone Number
310-400-7705
Fax Number
Provider Enumeration Date
03/14/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1687022 01 PA UNITED CONCORDIA
G92988-01 01 CA DENTICAL
1581480 05 AK
B49972-01 01 CA HEALTHY FAMILY
D49972 01 CA DENTICAL-RENDERING ID
institution
Provider Business Practice Location Address Details
Address
15201 S Western Ave
City
Gardena
State
California
Zip
90249-4314
Phone Number
310-400-7705
Fax Number
person
Provider Business Mailing Address Details
Address
15201 S Western Ave
City
Gardena
State
California
Zip
90249-4314
Phone Number
310-400-7705
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
49972 (California)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
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