Provider Demographics
NPI:1578777801
Name:PARK, HUNE JUNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HUNE
Middle Name:JUNE
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 EVERGREEN LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3270
Mailing Address - Country:US
Mailing Address - Phone:703-956-0071
Mailing Address - Fax:703-256-3066
Practice Address - Street 1:4322 EVERGREEN LN
Practice Address - Street 2:SUITE E
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3270
Practice Address - Country:US
Practice Address - Phone:703-956-0071
Practice Address - Fax:703-256-3066
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN152221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice