Provider Demographics
NPI:1144428194
Name:PARK, RODNEY KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:KIM
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6146 CAMINO VERDE DR
Mailing Address - Street 2:SUITE O
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1460
Mailing Address - Country:US
Mailing Address - Phone:408-224-7878
Mailing Address - Fax:408-224-3067
Practice Address - Street 1:6146 CAMINO VERDE DR
Practice Address - Street 2:SUITE O
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1460
Practice Address - Country:US
Practice Address - Phone:408-224-7878
Practice Address - Fax:408-224-3067
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 374771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice