Yoojun Park, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

22DI02573600 Issued in NJ

Practice address

401A South Van Brunt St Ste 205
Englewood, NJ 07631-4979

Phone

(201) 408-2808

Fax

(201) 227-0603

NPI assigned

Jul 21, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1972910107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401A SOUTH VAN BRUNT ST STE 205",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314979",
            "telephone_number": "201-408-2808",
            "fax_number": "201-227-0603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401A SOUTH VAN BRUNT ST STE 205",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314979",
            "telephone_number": "201-408-2808",
            "fax_number": "201-227-0603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "537 Anderson Ave",
            "address_purpose": "LOCATION",
            "city": "Cliffside Park",
            "state": "NJ",
            "postal_code": "070101722",
            "country_code": "US",
            "telephone_number": "917-815-6063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "YOOJUN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-21",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "22DI02573600",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "057340",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Park, OTR/L
• Jin Hyun Park
• Mie Hea Park
• Sae Yeon Park, APN
• Selin Park, FNP
• Richard Michael Parke, PTA
• Caroline Parpas, MD
• Pascack Valley Hospital
• Pascack Valley Surgical Association PA
• Felicia Maria Pasculli

• Periodontics in Englewood, NJ
• Providers in Englewood, NJ by specialty
• Periodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.