Provider Demographics
NPI:1922099902
Name:PARK, SUENG K (MD)
Entity Type:Individual
Prefix:
First Name:SUENG
Middle Name:K
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:PO BOX 3119
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3119
Mailing Address - Country:US
Mailing Address - Phone:713-481-3533
Mailing Address - Fax:713-432-0221
Practice Address - Street 1:4600 E SAM HOUSTON PKWY S
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3948
Practice Address - Country:US
Practice Address - Phone:713-481-3533
Practice Address - Fax:713-432-0221
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE19172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129866301Medicaid
TX129866306Medicaid
TX129866307Medicaid
TX8AN893OtherBCBS
TX8L20059Medicare PIN
TX8AN893OtherBCBS
TX8K3199Medicare PIN
TX129866301Medicaid
TX8F6303Medicare PIN
TX84R993Medicare PIN