Provider Demographics
NPI:1649313743
Name:PARK, SUNG H (MD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:H
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 1:1783 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-9108
Mailing Address - Country:US
Mailing Address - Phone:610-657-3473
Mailing Address - Fax:610-974-9337
Practice Address - Street 1:65 E ELIZABETH AVE
Practice Address - Street 2:SUITE 301A
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6518
Practice Address - Country:US
Practice Address - Phone:610-974-8500
Practice Address - Fax:610-974-9337
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033647L103T00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103T00000XBehavioral Health & Social Service ProvidersPsychologist