Provider Demographics
NPI:1245228030
Name:PARK, HONG S (MD)
Entity Type:Individual
Prefix:
First Name:HONG
Middle Name:S
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 1:5124 E TRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3623
Mailing Address - Country:US
Mailing Address - Phone:717-795-7943
Mailing Address - Fax:717-795-7942
Practice Address - Street 1:5124 E TRINDLE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3623
Practice Address - Country:US
Practice Address - Phone:717-795-7943
Practice Address - Fax:717-795-7942
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020835E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW0696855Medicaid
PW0696855Medicaid
PAC26233Medicare UPIN