Provider Demographics
NPI:1063026235
Name:PARK, SANGHYUN (DMD)
Entity type:Individual
Prefix:DR
First Name:SANGHYUN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1610 RIDENOUR BLVD NW STE 102
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4486
Mailing Address - Country:US
Mailing Address - Phone:215-582-3550
Mailing Address - Fax:
Practice Address - Street 1:1610 RIDENOUR BLVD NW STE 102
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4486
Practice Address - Country:US
Practice Address - Phone:678-273-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1236561223E0200X
NY0612921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics