Active NPI
Enyoung Park, DDS
- General Practice Dentistry
- Long Island City, NY
National Provider Identifier
1306097993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- P64476
- Practice address
- 3711 Queens Blvd
Long Island City, NY 11101-1725 - Phone
- (718) 361-5155
- NPI assigned
- Oct 1, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | P64476 | NY | Primary |
Addresses
Primary practice location
3711 Queens Blvd
Long Island City, NY 11101-1725
Mailing address
230 W 55TH St
Apt 16E
New York, NY 10019-5220
Phone (646) 942-2245
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 |
|---|---|---|---|
| P64476 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253491200000",
"number": "1306097993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 W 55TH ST",
"address_2": "APT 16E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100195220",
"telephone_number": "646-942-2245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3711 QUEENS BLVD",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111011725",
"telephone_number": "718-361-5155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ENYOUNG",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-01",
"last_updated": "2009-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "P64476",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Island City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.