Provider Demographics
NPI:1720271752
Name:PARK, TAE-HOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAE-HOON
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 TOLOFF ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3848
Mailing Address - Country:US
Mailing Address - Phone:907-333-6666
Mailing Address - Fax:907-331-1030
Practice Address - Street 1:726 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3739
Practice Address - Country:US
Practice Address - Phone:907-333-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560791223G0001X
AK1239711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice