Provider Demographics
NPI:1376512186
Name:PARK, SAUNG Z (MD)
Entity Type:Individual
Prefix:DR
First Name:SAUNG
Middle Name:Z
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:811 2ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3559
Mailing Address - Country:US
Mailing Address - Phone:320-631-7000
Mailing Address - Fax:320-632-0534
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7000
Practice Address - Fax:320-632-0534
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8467208G00000X
MN38468208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K2563Medicare PIN
MN020003005Medicare PIN
TXG21674Medicare UPIN
TX8K4863Medicare PIN