Provider Demographics
NPI:1811295413
Name:PARK, SEON HWA (LAC)
Entity type:Individual
Prefix:
First Name:SEON HWA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 W 32ND ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3880
Mailing Address - Country:US
Mailing Address - Phone:212-714-1004
Mailing Address - Fax:212-714-1009
Practice Address - Street 1:38 W 32ND ST STE 1001
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3880
Practice Address - Country:US
Practice Address - Phone:212-714-1004
Practice Address - Fax:212-714-1009
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004553246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other