Provider Demographics
NPI:1457632994
Name:PARK, SUN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUN
Middle Name:H
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11316 76TH RD
Mailing Address - Street 2:1F
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7236
Mailing Address - Country:US
Mailing Address - Phone:718-575-9548
Mailing Address - Fax:718-575-2969
Practice Address - Street 1:11316 76TH RD
Practice Address - Street 2:1F
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7236
Practice Address - Country:US
Practice Address - Phone:718-575-9548
Practice Address - Fax:718-575-2969
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist