MEDICARE: DR. HYUN K PARK D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	048635-1	NY

General Provider Information

NPI Number	:	1881790269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUN K PARK D.M.D.

Provider Business Mailing Address
First Line	:	2603 ROUTE 52
Second Line	:	SUITE E
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-3215
Country	:	US
Telephone Number	:	845-221-7700
Fax Number	:	845-227-7971

Provider Business Practice Location Address
First Line	:	2603 ROUTE 52
Second Line	:	SUITE E
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-3215
Country	:	US
Telephone Number	:	845-221-7700
Fax Number	:	845-227-7971

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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