Provider Demographics
NPI:1356374151
Name:OK H. PARK, M.D., L.L.C.
Entity type:Organization
Organization Name:OK H. PARK, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OK
Authorized Official - Middle Name:H
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-918-9007
Mailing Address - Street 1:9110 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4301
Mailing Address - Country:US
Mailing Address - Phone:410-918-9007
Mailing Address - Fax:410-918-9011
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:SUITE 213
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4301
Practice Address - Country:US
Practice Address - Phone:410-918-9007
Practice Address - Fax:410-918-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ727OtherCAREFIRST
GADD8163OtherRAILROAD MEDICARE
MD406613800Medicaid
MD767APAOtherCAREFIRST
GADD8163OtherRAILROAD MEDICARE