Park, Ethan Sb
Park, Ethan Sb is an sole proprietor health care provider with primary practice located at 5728 Rosemead Blvd Unit 220 , Temple City CA 91780-1814. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is his primary health care specialty. Park, Ethan Sb can be contacted via phone (626) 500-4340.Contact Information
Primary practice address
5728 Rosemead Blvd Unit 220
Temple City CA 91780-1814
Phone: (626) 500-4340
Fax: (626) 544-5335
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 100873 | California |
| Dental Providers / Dentist | 122300000X | 100873 | California |
Profile Details
| NPI number | 1144779828 |
|---|---|
| LBN Legal business name | Park, Ethan Sb |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 23rd, 2016 |
| Last updated | Jul 12th, 2023 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144779828 | NPPES |
| California | Other | 100873 | DENTIST |
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