1548212004 NPI number — HYE-RAN PARK M.D.

Table of content: (NPI 1972841625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548212004 NPI number — HYE-RAN PARK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARK
Provider First Name:
HYE-RAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548212004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W SPROUL RD STE 224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19064-2033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-789-6320
Provider Business Mailing Address Fax Number:
484-471-3917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W SPROUL RD STE 224
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-789-6320
Provider Business Practice Location Address Fax Number:
484-471-3917
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  MD423010 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1015894400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6775688 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7060821 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02191 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2710482000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1853548 . This is a "BLSH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30035239 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00367106 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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