Active NPI
Eunjung Park, DDS, MA
- Pediatric Dentistry
- Harrison, NY
National Provider Identifier
1376031971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 061244
- Practice address
- 450 Mamaroneck Ave Ste 403
Harrison, NY 10528-2436 - Phone
- (914) 777-1140
- NPI assigned
- Apr 29, 2018
- Last updated
- Sep 6, 2021
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 061244 | NY | Primary |
Addresses
Primary practice location
450 Mamaroneck Ave Ste 403
Harrison, NY 10528-2436
Mailing address
450 Mamaroneck Ave Ste 403
Harrison, NY 10528-2436
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061244 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630886400000",
"number": "1376031971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 MAMARONECK AVE STE 403",
"city": "HARRISON",
"state": "NY",
"postal_code": "105282436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 MAMARONECK AVE STE 403",
"city": "HARRISON",
"state": "NY",
"postal_code": "105282436",
"telephone_number": "914-777-1140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "EUNJUNG",
"name_prefix": "Dr.",
"credential": "DDS, MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-29",
"last_updated": "2021-09-06",
"certification_date": "2021-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "061244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harrison, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.