Provider Demographics
NPI:1568404481
Name:PARK, MICHAEL HYUNGWOOK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HYUNGWOOK
Last Name:PARK
Suffix:
Gender:M
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:2790 LAKE VISTA DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3884
Practice Address - Country:US
Practice Address - Phone:972-459-1300
Practice Address - Fax:972-459-1382
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8708207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1520OtherBLUE CROSS OF TEXAS
TX129006605Medicaid
TX129006603Medicaid
TX129006604Medicaid
TX8078J0Medicare PIN
G17077Medicare UPIN
TX129006605Medicaid
TXTXB112603Medicare PIN
TXTXB112604Medicare PIN
TX8807J3Medicare PIN
TX8G0248Medicare PIN