Provider Demographics
NPI:1417031394
Name:PARK, SOON HO (MD)
Entity Type:Individual
Prefix:DR
First Name:SOON
Middle Name:HO
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4309 W MEDICAL CENTER DR
Mailing Address - Street 2:SUITE A201
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8419
Mailing Address - Country:US
Mailing Address - Phone:815-385-0084
Mailing Address - Fax:815-385-8968
Practice Address - Street 1:4309 W MEDICAL CENTER DR
Practice Address - Street 2:SUITE A201
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8419
Practice Address - Country:US
Practice Address - Phone:815-385-0084
Practice Address - Fax:815-385-8968
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology