Provider Demographics
NPI:1215941661
Name:PARK, JUNHIE YOUNGKYUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:JUNHIE
Middle Name:YOUNGKYUNG
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 BUCKINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-9341
Mailing Address - Country:US
Mailing Address - Phone:919-469-4551
Mailing Address - Fax:
Practice Address - Street 1:1148 EXECUTIVE CIR STE 4
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4575
Practice Address - Country:US
Practice Address - Phone:919-469-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice