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General NPI Number Information
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NPI Number | 1962212563
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Entity Type | Individual
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Provider Name | SEO HYUN PARK
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 460 SYLVAN AVE FL 1
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2943
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Country | US
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Telephone | 201-608-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 107 TRINITY CT
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City | SAUGERTIES
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State | NY
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Zip | 12477-5127
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 064633
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02922200
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License Number State | NJ
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