Provider Demographics
NPI:1043304355
Name:PARK, HEAKYOUNG (MD)
Entity Type:Individual
Prefix:
First Name:HEAKYOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E 180 ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460
Mailing Address - Country:US
Mailing Address - Phone:718-716-2089
Mailing Address - Fax:718-716-2089
Practice Address - Street 1:817 E 180 ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:718-716-2089
Practice Address - Fax:718-294-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics