Provider Demographics
NPI:1326822669
Name:PARK, HEEJUNG (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:HEEJUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 HEARTHSIDE WAY UNIT 408
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7605
Mailing Address - Country:US
Mailing Address - Phone:412-334-2947
Mailing Address - Fax:
Practice Address - Street 1:1403 MADISON PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6292
Practice Address - Country:US
Practice Address - Phone:410-582-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224697363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics