Provider Demographics
NPI:1174882088
Name:PARK-HYUN, EUNHAE
Entity type:Individual
Prefix:DR
First Name:EUNHAE
Middle Name:
Last Name:PARK-HYUN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EUNHAE
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3734 CARMAN RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5422
Mailing Address - Country:US
Mailing Address - Phone:716-706-9975
Mailing Address - Fax:
Practice Address - Street 1:3734 CARMAN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-356-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY561131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice