Provider Demographics
NPI:1285616417
Name:PARK, HUI BYUNG (DDS)
Entity type:Individual
Prefix:MR
First Name:HUI
Middle Name:BYUNG
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:BYUNG
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:13678 39TH AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5515
Mailing Address - Country:US
Mailing Address - Phone:718-939-1144
Mailing Address - Fax:718-939-4929
Practice Address - Street 1:13678 39TH AVE
Practice Address - Street 2:STE 206
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5515
Practice Address - Country:US
Practice Address - Phone:718-939-1144
Practice Address - Fax:718-939-4929
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0333141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00288862Medicaid