| Woo Sung Park Dental Corp | |
|
3130 W Olympic Blvd Ste 320 Los Angeles CA 90006-2494 | |
| (323) 766-2888 | |
| Not Available |
| Full Name | Woo Sung Park Dental Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 3130 W Olympic Blvd Ste 320, Los Angeles, California |
| Authorized Official Name and Position | Woo Sung Park (OWNER) |
| Authorized Official Contact | 7145535977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Woo Sung Park Dental Corp 3130 W Olympic Blvd Ste 320 Los Angeles CA 90006-2494 Ph: (323) 766-2888 | Woo Sung Park Dental Corp 3130 W Olympic Blvd Ste 320 Los Angeles CA 90006-2494 Ph: (323) 766-2888 |
| NPI Number | 1346605672 |
|---|---|
| Provider Enumeration Date | 12/31/2015 |
| Last Update Date | 12/31/2015 |
| Medicare PECOS PAC ID | 5799064903 |
|---|---|
| Medicare Enrollment ID | O20161110002067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346605672 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 54186 (California) | Primary |
| Provider Name | Woo Sung Park |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1144454869 PECOS PAC ID: 8729380506 Enrollment ID: I20161110002123 |
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