| Bojun Park Dds Inc | |
|
1112 S Bristol St Santa Ana CA 92704-3420 | |
| (714) 668-9884 | |
| (714) 668-0381 |
| Full Name | Bojun Park Dds Inc |
|---|---|
| Speciality | Dentist |
| Location | 1112 S Bristol St, Santa Ana, California |
| Authorized Official Name and Position | Bojun Park (DDS, CEO) |
| Authorized Official Contact | 7146689884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bojun Park Dds Inc 1112 S Bristol St Santa Ana CA 92704-3420 Ph: (714) 668-9884 | Bojun Park Dds Inc 1112 S Bristol St Santa Ana CA 92704-3420 Ph: (714) 668-9884 |
| NPI Number | 1669908299 |
|---|---|
| Provider Enumeration Date | 05/02/2017 |
| Last Update Date | 05/02/2017 |
| Medicare PECOS PAC ID | 7810269438 |
|---|---|
| Medicare Enrollment ID | O20170816004257 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669908299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 56290 (California) | Primary |
| Provider Name | Bojun Park |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1922293398 PECOS PAC ID: 4880993716 Enrollment ID: I20170816004373 |
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