Provider Demographics
NPI:1952327215
Name:PARK, KILHONG (MD)
Entity Type:Individual
Prefix:DR
First Name:KILHONG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14150 NE 20TH ST F1
Mailing Address - Street 2:#402
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007
Mailing Address - Country:US
Mailing Address - Phone:425-454-6868
Mailing Address - Fax:425-454-6869
Practice Address - Street 1:14150 NE 20TH ST STE F1
Practice Address - Street 2:#402
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3700
Practice Address - Country:US
Practice Address - Phone:425-454-6868
Practice Address - Fax:425-454-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA39915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H48513Medicare UPIN