Provider Demographics
NPI:1831614387
Name:PARK, DAVID JI HYUN (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JI HYUN
Last Name:PARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 DUNLAP ST N STE 308
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4223
Mailing Address - Country:US
Mailing Address - Phone:443-759-0910
Mailing Address - Fax:
Practice Address - Street 1:393 DUNLAP ST N STE 308
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4223
Practice Address - Country:US
Practice Address - Phone:443-759-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-06
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND139051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice