MEDICARE: EUIJOON PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DB-2025-0154	NM
2	122300000X	Dentist	DN29562	FL
3	122300000X	Dentist	101669	CA
4	122300000X	Dentist	41168	TX
5	122300000X	Dentist	00205471	CO

General Provider Information

NPI Number	:	1093238610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUIJOON PARK

Provider Business Mailing Address
First Line	:	8749 E 23RD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3138
Country	:	US
Telephone Number	:	216-392-3729
Fax Number	:

Provider Business Practice Location Address
First Line	:	11175 E MISSISSIPPI AVE STE 110
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-3137
Country	:	US
Telephone Number	:	303-723-9631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	08/22/2025

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Directions to “ EUIJOON PARK ” Practice Location

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