Provider Demographics
NPI:1295732808
Name:PARK, HYO-JONG (MD)
Entity type:Individual
Prefix:DR
First Name:HYO-JONG
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 1:2460 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2648
Mailing Address - Country:US
Mailing Address - Phone:702-822-2000
Mailing Address - Fax:702-938-2237
Practice Address - Street 1:2460 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2648
Practice Address - Country:US
Practice Address - Phone:702-822-2000
Practice Address - Fax:702-938-2237
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5705207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002611Medicaid
NV080107302OtherRAILROAD MEDICARE
AZ900001899OtherRAILROAD MEDICARE
AZ179839Medicaid
AZ179839Medicaid
NV080107302OtherRAILROAD MEDICARE
NV30007Medicare PIN