Provider Demographics
NPI:1073575601
Name:PARK, MD, PLLC, KWANG-HIE (MD)
Entity Type:Individual
Prefix:
First Name:KWANG-HIE
Middle Name:
Last Name:PARK, MD, PLLC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KWANG
Other - Middle Name:HIE
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:901 BOREN AVENUE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3508
Mailing Address - Country:US
Mailing Address - Phone:206-682-8900
Mailing Address - Fax:206-624-1489
Practice Address - Street 1:901 BOREN AVENUE
Practice Address - Street 2:SUITE 1020
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3508
Practice Address - Country:US
Practice Address - Phone:206-682-8900
Practice Address - Fax:206-624-1489
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD-000455492084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8439572Medicaid
WA8239572Medicaid
WA8239572Medicaid
WA8856985Medicare PIN
OHE73507Medicare UPIN