Provider Demographics
NPI:1023526837
Name:PARK, HEE JIN (DMD)
Entity type:Individual
Prefix:DR
First Name:HEE
Middle Name:JIN
Last Name:PARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 ROSEPINE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6692
Mailing Address - Country:US
Mailing Address - Phone:919-740-9373
Mailing Address - Fax:
Practice Address - Street 1:3607 DAVIS DR STE 209
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6005
Practice Address - Country:US
Practice Address - Phone:919-469-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice