Provider Demographics
NPI:1689188690
Name:PARK, HYUN SUK
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:SUK
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 3RD AVE APT 20F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3456
Mailing Address - Country:US
Mailing Address - Phone:212-395-9000
Mailing Address - Fax:212-722-7181
Practice Address - Street 1:1072 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3901
Practice Address - Country:US
Practice Address - Phone:212-395-9000
Practice Address - Fax:212-722-7181
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340049364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health