Provider Demographics
NPI:1366456808
Name:PARK KUO, SUN (DMD)
Entity Type:Individual
Prefix:
First Name:SUN
Middle Name:
Last Name:PARK KUO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SUN
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5225 EHRLICH RD STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2066
Mailing Address - Country:US
Mailing Address - Phone:239-888-9266
Mailing Address - Fax:
Practice Address - Street 1:5225 EHRLICH RD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2066
Practice Address - Country:US
Practice Address - Phone:239-888-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist