Provider Demographics
NPI:1639734627
Name:JUNG H PARK DDS LLC
Entity Type:Organization
Organization Name:JUNG H PARK DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-679-8959
Mailing Address - Street 1:7900 ANDRUS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3167
Mailing Address - Country:US
Mailing Address - Phone:703-679-8959
Mailing Address - Fax:
Practice Address - Street 1:7900 ANDRUS RD STE 1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3167
Practice Address - Country:US
Practice Address - Phone:703-679-8959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental