Provider Demographics
NPI:1508805839
Name:PARK, HAI SUN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAI SUN
Middle Name:
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 1:464 HUDSON TER STE 200
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2917
Mailing Address - Country:US
Mailing Address - Phone:201-408-5442
Mailing Address - Fax:201-408-5459
Practice Address - Street 1:464 HUDSON TER STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2917
Practice Address - Country:US
Practice Address - Phone:201-408-5442
Practice Address - Fax:201-503-0848
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53599207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K2842OtherHEALTHNET
NJ2195084OtherAETNA
NJ7446004Medicaid
NY14B02OtherEMPIRE HEALTHCARE
NJBS696OtherOXFORD
NJ617916CDFMedicare PIN
NJ7446004Medicaid