Provider Demographics
NPI:1588866321
Name:PARK, HYUN (DDS)
Entity type:Individual
Prefix:DR
First Name:HYUN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:HYUN PARK
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:509 48TH AVE
Mailing Address - Street 2:#4H
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5604
Mailing Address - Country:US
Mailing Address - Phone:646-265-0408
Mailing Address - Fax:
Practice Address - Street 1:230 PARK AVE
Practice Address - Street 2:1164
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10169-0005
Practice Address - Country:US
Practice Address - Phone:646-265-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice