Provider Demographics
NPI:1205974706
Name:PARK, SO HYANG (MD)
Entity type:Individual
Prefix:DR
First Name:SO
Middle Name:HYANG
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SO HYANG
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-721-4840
Mailing Address - Fax:717-738-3558
Practice Address - Street 1:460 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9606
Practice Address - Country:US
Practice Address - Phone:717-738-4070
Practice Address - Fax:717-738-3558
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062484L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01919427Medicaid
PAH75556Medicare UPIN
PA064658Q43Medicare ID - Type Unspecified