MEDICARE: DR. HYUN PARK D.D.S.

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	1223G0001X	General Practice Dentistry	052165	NY

General Provider Information

NPI Number	:	1588866321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUN PARK D.D.S.

Provider Business Mailing Address
First Line	:	509 48TH AVE
Second Line	:	#4H
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5604
Country	:	US
Telephone Number	:	646-265-0408
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 PARK AVE
Second Line	:	1164
City	:	NEW YORK
State	:	NY
Zip	:	10169-0005
Country	:	US
Telephone Number	:	646-265-0408
Fax Number	:

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	09/30/2010

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