Provider Demographics
NPI:1245217561
Name:PARK, PHILIP DUHEUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DUHEUNG
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE C-305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6012
Mailing Address - Country:US
Mailing Address - Phone:808-593-0078
Mailing Address - Fax:
Practice Address - Street 1:725 KAPIOLANI BLVD
Practice Address - Street 2:SUITE C-305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6012
Practice Address - Country:US
Practice Address - Phone:808-593-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-17171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI821913OtherTRI CARE
HIA9282-3OtherHMSA
HI1717OtherHDS
HI071378-01Medicaid