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NPI Code Detail

MEDICARE: HYUNJUNG PARK

MEDICARE: HYUNJUNG 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
1122300000XDentistDD4432NM

General Provider Information

NPI Number : 1639535560
Entity Type Code : Individual
Provider Name (Legal Business Name) : HYUNJUNG PARK
Provider Business Mailing Address
First Line : 350 N CLARK ST FL 6
Second Line : DENTAL DREAMS LLC C/O JULIETTE BOYCE
City : CHICAGO
State : IL
Zip : 60654-4712
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4201 CENTRAL AVE NW STE F1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87105-1669
Country : US
Telephone Number : 505-843-7172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2016
Last Update Date : 01/07/2016

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Directions to “ HYUNJUNG PARK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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