Provider Demographics
NPI:1780760132
Name:PARK, HO-HYUN (MD)
Entity type:Individual
Prefix:DR
First Name:HO-HYUN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HO
Other - Middle Name:H
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1322 SUSQUEHANNA RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1827
Mailing Address - Country:US
Mailing Address - Phone:215-572-5404
Mailing Address - Fax:215-572-1184
Practice Address - Street 1:521 PLYMOUTH RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1638
Practice Address - Country:US
Practice Address - Phone:610-941-3390
Practice Address - Fax:610-941-3391
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-031306-L2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA654087Medicaid
PA110158Medicare ID - Type Unspecified
PAC-30400Medicare UPIN