Provider Demographics
NPI:1053767996
Name:PARK, SUNMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNMIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE #304
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4451
Mailing Address - Country:US
Mailing Address - Phone:703-821-0080
Mailing Address - Fax:703-821-0032
Practice Address - Street 1:1515 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE #304
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4451
Practice Address - Country:US
Practice Address - Phone:703-821-0080
Practice Address - Fax:703-821-0032
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist