Provider Demographics
NPI:1083833016
Name:PARK, HYUNG BAI (PT)
Entity Type:Individual
Prefix:MR
First Name:HYUNG
Middle Name:BAI
Last Name:PARK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W OCEAN BLVD
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4513
Mailing Address - Country:US
Mailing Address - Phone:310-938-4493
Mailing Address - Fax:
Practice Address - Street 1:400 W OCEAN BLVD
Practice Address - Street 2:SUITE 1105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4513
Practice Address - Country:US
Practice Address - Phone:310-938-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist