Provider Demographics
NPI:1417509746
Name:IN KWON PARK MD PLLC
Entity Type:Organization
Organization Name:IN KWON PARK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:IN KWON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-212-3637
Mailing Address - Street 1:8730 S TACOMA WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4521
Mailing Address - Country:US
Mailing Address - Phone:253-212-3637
Mailing Address - Fax:253-267-0153
Practice Address - Street 1:8730 S TACOMA WAY STE 104
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4521
Practice Address - Country:US
Practice Address - Phone:253-212-3637
Practice Address - Fax:253-267-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty