Provider Demographics
NPI:1215114301
Name:PARK, YONG JUN DAVID (DDS MD)
Entity type:Individual
Prefix:DR
First Name:YONG JUN
Middle Name:DAVID
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:YONG
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS MD
Mailing Address - Street 1:12777 VALLEYVIEW ST. #121
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-8318
Mailing Address - Country:US
Mailing Address - Phone:714-897-3543
Mailing Address - Fax:714-897-0505
Practice Address - Street 1:12777 VALLEY VIEW ST STE 121
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2521
Practice Address - Country:US
Practice Address - Phone:714-897-3543
Practice Address - Fax:714-897-0505
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery