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
Fax: (626) 544-5335
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144779828 NPPES
California Other 100873 DENTIST

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