Provider Demographics
NPI:1548600372
Name:PARK, DONG-WOUK (MD)
Entity Type:Individual
Prefix:
First Name:DONG-WOUK
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DONG-WOUK
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:600 TRIANGLE SHOPPING CTR STE 400
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4677
Mailing Address - Country:US
Mailing Address - Phone:360-423-0220
Mailing Address - Fax:
Practice Address - Street 1:600 TRIANGLE SHOPPING CTR STE 400
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4677
Practice Address - Country:US
Practice Address - Phone:360-423-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136294207W00000X
WAMD.61032551207WX0107X
WI67129207W00000X
ORMD197648207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology