Active NPI
Yong Suel Park, DDS
- General Practice Dentistry
- Vernon, NJ
National Provider Identifier
1972027225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11859
- Practice address
- 292 Route 94
Vernon, NJ 07462-3181 - Phone
- (973) 827-2255
- NPI assigned
- Jul 28, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 11859 | CT | Primary |
Addresses
Primary practice location
292 Route 94
Vernon, NJ 07462-3181
Mailing address
PO Box 195
Vernon, NJ 07462-0195
Phone (716) 449-3067
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 |
|---|---|---|---|
| 11859 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551139200000",
"number": "1972027225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 195",
"city": "VERNON",
"state": "NJ",
"postal_code": "074620195",
"telephone_number": "716-449-3067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "292 ROUTE 94",
"city": "VERNON",
"state": "NJ",
"postal_code": "074623181",
"telephone_number": "973-827-2255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "YONG",
"middle_name": "SUEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-28",
"last_updated": "2019-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "11859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vernon, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.