Active NPI
Yeun-June Park, DMD, MSD
- Prosthodontics
- Philadelphia, PA
National Provider Identifier
1457482812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- DS035815
- Practice address
- 1512 Sansom St
#300
Philadelphia, PA 19102-2809 - Phone
- (215) 564-0717
- Fax
- (215) 564-5450
- NPI assigned
- Mar 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | DS035815 | PA | Primary |
Addresses
Primary practice location
1512 Sansom St
#300
Philadelphia, PA 19102-2809
Mailing address
1512 Sansom St
#300
Philadelphia, PA 19102-2809
Phone (215) 564-0717
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 |
|---|---|---|---|
| DS035815 | PA | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Dental Associates P.C. | Prosthodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prosthodontics
- Philadelphia, PA
- NPI 1164709093
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320624000000",
"number": "1457482812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1512 SANSOM ST",
"address_2": "#300",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191022809",
"telephone_number": "215-564-0717",
"fax_number": "215-564-5450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1512 SANSOM ST",
"address_2": "#300",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191022809",
"telephone_number": "215-564-0717",
"fax_number": "215-564-5450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "YEUN-JUNE",
"credential": "DMD, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2011-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "PA",
"license": "DS035815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.