Provider Demographics
NPI:1740389337
Name:PARK, MIN S (MD)
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:S
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 1:515 MINOR AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2120
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-576-3802
Practice Address - Street 1:515 MINOR AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2120
Practice Address - Country:US
Practice Address - Phone:206-386-9500
Practice Address - Fax:206-576-3802
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60211829207RX0202X
PA427077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0824PAOtherREGENCE
TX202672602Medicaid
WA279756OtherLNI
WA1740389337Medicaid
TX202672602Medicaid
WA279756OtherLNI