Provider Demographics
NPI:1689682189
Name:PARK, HYUN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:HYUN
Middle Name:S
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:DOUGLAS
Other - Middle Name:HS
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1717 S 324TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8500
Mailing Address - Country:US
Mailing Address - Phone:253-815-0093
Mailing Address - Fax:
Practice Address - Street 1:1717 S 324TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8500
Practice Address - Country:US
Practice Address - Phone:253-815-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE72781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice