1780760132 NPI number — DR. HO-HYUN PARK M.D.

Table of content: DR. HO-HYUN PARK M.D. (NPI 1780760132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780760132 NPI number — DR. HO-HYUN PARK M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARK
Provider Other First Name:
HO
Provider Other Middle Name:
H.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780760132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1322 SUSQUEHANNA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RYDAL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-1827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-572-5404
Provider Business Mailing Address Fax Number:
215-572-1184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 PLYMOUTH RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-941-3390
Provider Business Practice Location Address Fax Number:
610-941-3391
Provider Enumeration Date:
10/28/2006

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: 2084P0804X , with the licence number:  MD-031306-L , 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: 654087 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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