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General NPI Number Information
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NPI Number | 1689935389
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Entity Type | Individual
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Provider Name | VICTORIA JEONG PARK DDS
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Gender | Female
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 47 E 77TH ST STE 207
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City | NEW YORK
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State | NY
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Zip | 10075-1730
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Country | US
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Telephone | 646-707-3456
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Fax |
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Provider Business Mailing Address
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Address Line | 47 E 77TH ST STE 207
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City | NEW YORK
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State | NY
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Zip | 10075-1730
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Country | US
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Telephone | 646-707-3456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 057864
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 057864
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License Number State | NY
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