Provider Demographics
NPI:1134139397
Name:PARK, SUN KUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUN
Middle Name:KUN
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 ANNAPOLIS RD STE A
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1328
Mailing Address - Country:US
Mailing Address - Phone:410-674-7400
Mailing Address - Fax:410-674-7674
Practice Address - Street 1:1223 ANNAPOLIS RD STE A
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1328
Practice Address - Country:US
Practice Address - Phone:410-674-7400
Practice Address - Fax:410-674-7674
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist