Provider Demographics
NPI:1902056930
Name:SANGHO PARK DENTAL INC
Entity Type:Organization
Organization Name:SANGHO PARK DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-776-0449
Mailing Address - Street 1:699 WAKE AVE
Mailing Address - Street 2:#63
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9598
Mailing Address - Country:US
Mailing Address - Phone:516-776-0449
Mailing Address - Fax:760-353-4887
Practice Address - Street 1:603 WAKE AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-7500
Practice Address - Country:US
Practice Address - Phone:516-776-0449
Practice Address - Fax:760-353-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty