| Jino Park Dds Dental Corporation | |
|
24950 Redlands Blvd Ste B Loma Linda CA 92354-4028 | |
| (909) 478-9777 | |
| (909) 478-9526 |
| Full Name | Jino Park Dds Dental Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 24950 Redlands Blvd Ste B, Loma Linda, California |
| Authorized Official Name and Position | Jino Park (OWNER) |
| Authorized Official Contact | 9099693503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jino Park Dds Dental Corporation 24950 Redlands Blvd Ste B Loma Linda CA 92354-4028 Ph: (909) 478-9777 | Jino Park Dds Dental Corporation 24950 Redlands Blvd Ste B Loma Linda CA 92354-4028 Ph: (909) 478-9777 |
| NPI Number | 1164110151 |
|---|---|
| Provider Enumeration Date | 04/27/2023 |
| Last Update Date | 08/31/2023 |
| Medicare PECOS PAC ID | 7214381706 |
|---|---|
| Medicare Enrollment ID | O20231003000884 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164110151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Jino Park |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1912246356 PECOS PAC ID: 7618321712 Enrollment ID: I20230922002516 |
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