| JC Park DDS Inc | |
|
1505 S Riverside Ave Unit B Rialto CA 92376-7725 | |
| (909) 440-5345 | |
| Not Available |
| Full Name | JC Park DDS Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1505 S Riverside Ave Unit B, Rialto, California |
| Authorized Official Name and Position | Jaechan Park (CEO) |
| Authorized Official Contact | 6264540159 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| JC Park DDS Inc 15201 S Western Ave Gardena CA 90249-4314 Ph: (310) 400-7705 | JC Park DDS Inc 1505 S Riverside Ave Unit B Rialto CA 92376-7725 Ph: (909) 440-5345 |
| NPI Number | 1609636810 |
|---|---|
| Provider Enumeration Date | 03/22/2024 |
| Last Update Date | 03/22/2024 |
| Certification Date | 03/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609636810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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