Provider Demographics
NPI:1255588679
Name:PARK, IN KWON (MD)
Entity type:Individual
Prefix:
First Name:IN KWON
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 S TACOMA WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4521
Mailing Address - Country:US
Mailing Address - Phone:253-212-3637
Mailing Address - Fax:253-267-0153
Practice Address - Street 1:8730 S TACOMA WAY STE 104
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4521
Practice Address - Country:US
Practice Address - Phone:253-212-3637
Practice Address - Fax:253-267-0153
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC137595207R00000X
WAMD60044488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine