Provider Demographics
NPI:1093753162
Name:PARK, MYUNG (MD)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
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:PO BOX 6636
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6636
Mailing Address - Country:US
Mailing Address - Phone:361-694-5086
Mailing Address - Fax:361-855-9518
Practice Address - Street 1:3533 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5086
Practice Address - Fax:361-855-9518
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE58812080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103316OtherSUPERIOR HEALTHPLAN
TX8H9855OtherBCBSTX
TX117824604Medicaid
TX117824604OtherCSHCN
TXC20183Medicare UPIN
TX117824604Medicaid