Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 061292 | NY |
NPI | 1063026235 |
---|---|
Provider Name | Dr. Sanghyun Park |
First Address | Garden City, NY 11530-4886 |
Second Address | Garden City, NY 11530-4886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 29/09/2020 |