Provider Demographics
NPI:1164434064
Name:PARK, HYE YOUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:HYE
Middle Name:YOUNG
Last Name:PARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 CHANDLER CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2800
Mailing Address - Country:US
Mailing Address - Phone:301-705-9737
Mailing Address - Fax:301-893-2194
Practice Address - Street 1:956 CHANDLER CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2800
Practice Address - Country:US
Practice Address - Phone:301-705-9737
Practice Address - Fax:301-893-2194
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice