Park, Jaechan

Park, Jaechan is an sole proprietor health care provider with primary practice located at 15201 S Western Ave , Gardena CA 90249-4314. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Park, Jaechan can be contacted via phone (310) 400-7705.

Contact Information

Primary practice address
15201 S Western Ave Gardena CA 90249-4314
Phone: (310) 400-7705
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 49972 California

Profile Details

NPI number 1275666315
LBN Legal business name Park, Jaechan
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 14th, 2007
Last updated Mar 13th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275666315 NPPES
Pennsylvania Other 1687022 UNITED CONCORDIA
Pennsylvania Other G92988-01 UNITED CONCORDIA
Pennsylvania MEDICAID 1581480 UNITED CONCORDIA
Pennsylvania Other B49972-01 UNITED CONCORDIA
Pennsylvania Other D49972 UNITED CONCORDIA

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