Park, Soo Tae
Park, Soo Tae is an sole proprietor health care provider with primary practice located at 44841 N 10Th St W , Lancaster CA 93534. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Park, Soo Tae can be contacted via phone (661) 948-1655.Contact Information
Primary practice address
44841 N 10Th St W
Lancaster CA 93534
Phone: (661) 948-1655
Fax: (661) 940-9636
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 33967 | California |
Profile Details
| NPI number | 1124084728 |
|---|---|
| LBN Legal business name | Park, Soo Tae |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 22nd, 2006 |
| Last updated | Oct 9th, 2013 - about 13 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 | 1124084728 | NPPES |
| California | MEDICAID | G9225701 |
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