Provider Demographics
NPI:1457482812
Name:PARK, YEUN-JUNE (DMD, MSD)
Entity Type:Individual
Prefix:
First Name:YEUN-JUNE
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 SANSOM ST
Mailing Address - Street 2:#300
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2809
Mailing Address - Country:US
Mailing Address - Phone:215-564-0717
Mailing Address - Fax:215-564-5450
Practice Address - Street 1:1512 SANSOM ST
Practice Address - Street 2:#300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2809
Practice Address - Country:US
Practice Address - Phone:215-564-0717
Practice Address - Fax:215-564-5450
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics