Individual
SI-EUN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1600 DUKE ST STE 150, ALEXANDRIA, VA 22314-6122
(703) 276-1110
Mailing address
4060 GATEWAY DR APT 5507, FAIRFAX, VA 22030-5062
(330) 631-3238
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401418414
VA
1223G0001X
General Practice Dentistry
Primary
105315
CA
Other
Enumeration date
06/05/2019
Last updated
07/22/2026
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