Provider Demographics
NPI:1972910107
Name:PARK, YOOJUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOOJUN
Middle Name:
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 1:401A SOUTH VAN BRUNT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4979
Mailing Address - Country:US
Mailing Address - Phone:201-408-2808
Mailing Address - Fax:201-227-0603
Practice Address - Street 1:401A SOUTH VAN BRUNT ST STE 205
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4979
Practice Address - Country:US
Practice Address - Phone:201-408-2808
Practice Address - Fax:201-227-0603
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025736001223P0300X
NY0573401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics