Active NPI
Kwanyong Park
- Dentist
- New Hyde Park, NY
National Provider Identifier
1255084182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 063235
- Practice address
- 27005 76TH Ave
New Hyde Park, NY 11040-1402 - Phone
- (718) 470-7000
- NPI assigned
- Jan 31, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 063235 | NY | |
| Dentist | 122300000X | 063235 | NY | Primary |
Addresses
Primary practice location
27005 76TH Ave
New Hyde Park, NY 11040-1402
Mailing address
4155 Bowne St
Flushing, NY 11355-2690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 063235 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779753600000",
"number": "1255084182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4155 BOWNE ST",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113552690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27005 76TH AVE",
"city": "NEW HYDE PARK",
"state": "NY",
"postal_code": "110401402",
"telephone_number": "718-470-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "KWANYONG",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-01-31",
"last_updated": "2026-05-26",
"certification_date": "2026-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "063235",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "063235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Hyde Park, NY
- Chang J Park, MD
- Ji Young Park, NP
- John Joon Kyu Park, M.D.
- Joo-Eun Samuel Park, MD
- Kathy Park, RPH, MS
- Won Park, MD
- Parker Jewish Institute for Health Care and Rehabilitation
- Parker Jewish Institute for Health Care and Rehabilitation
- Parker Jewish Institute for Health Care and Rehabilitation
- Parker Jewish Institute for Health Care and Rehabilitation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.