Provider Demographics
NPI:1285626887
Name:PARK, DONG HEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:HEE
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 1:719 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5309
Mailing Address - Country:US
Mailing Address - Phone:410-398-2700
Mailing Address - Fax:410-620-1249
Practice Address - Street 1:719 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5309
Practice Address - Country:US
Practice Address - Phone:410-398-2700
Practice Address - Fax:410-620-1249
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD633900000Medicaid