Provider Demographics
NPI:1992905541
Name:PARK, EUN MI (DDS)
Entity type:Individual
Prefix:DR
First Name:EUN
Middle Name:MI
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 1:30 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3019
Mailing Address - Country:US
Mailing Address - Phone:212-679-4300
Mailing Address - Fax:212-661-4427
Practice Address - Street 1:30 E 37TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3019
Practice Address - Country:US
Practice Address - Phone:212-679-4300
Practice Address - Fax:212-661-4427
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052879-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052879-1OtherNEW YORK STATE LICENSE NU