David Ji Hyun Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13905 Issued in MN

Practice address

393 Dunlap St N Ste 308
Saint Paul, MN 55104-4223

Phone

(443) 759-0910

NPI assigned

Aug 6, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514851200000",
    "number": "1831614387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 DUNLAP ST N STE 308",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044223",
            "telephone_number": "443-759-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 DUNLAP ST N STE 308",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044223",
            "telephone_number": "443-759-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DAVID",
        "middle_name": "JI HYUN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-06",
        "last_updated": "2018-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Avenue Family Practice
• Park Avenue Family Practice
• Juli A Park Jankowski, RPH
• Park Nicollet Health Care Products
• Christine Park, CPNP
• Hanbyul William Park, MD
• Minerva C Park, DDS
• Tiffany Deborah Park, M.A., CCC-SLP
• Michelle Erin Parker
• Stephen Anthony Parker, PSYD LP

• General Practice Dentistry in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.