Provider Demographics
NPI:1649333790
Name:PARK, DOO SIK (MD)
Entity type:Individual
Prefix:
First Name:DOO
Middle Name:SIK
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 1:40 44 82ND STREET
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1305
Mailing Address - Country:US
Mailing Address - Phone:718-429-3800
Mailing Address - Fax:718-429-4224
Practice Address - Street 1:40 44 82ND STREET
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1305
Practice Address - Country:US
Practice Address - Phone:718-429-3800
Practice Address - Fax:718-429-4224
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136902207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92F132OtherEMPIRE BCBS
NY00545120Medicaid
NY92F131OtherEMPIRE BLUE CHOICE PPO
NY92F132OtherEMPIRE BCBS
35000Medicare ID - Type Unspecified