Provider Demographics
NPI:1932337896
Name:PARK, WON HEE (DO)
Entity Type:Individual
Prefix:DR
First Name:WON
Middle Name:HEE
Last Name:PARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7585 KITTY HAWK, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109
Mailing Address - Country:US
Mailing Address - Phone:210-468-2323
Mailing Address - Fax:
Practice Address - Street 1:7585 KITTY HAWK, SUITE 201
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109
Practice Address - Country:US
Practice Address - Phone:210-468-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297852001Medicaid
TX297852001Medicaid