Provider Demographics
NPI:1952149304
Name:PARK, HYUNYONG
Entity type:Individual
Prefix:
First Name:HYUNYONG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6386 TRANSIT RD APT 339
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1125
Mailing Address - Country:US
Mailing Address - Phone:201-364-5553
Mailing Address - Fax:
Practice Address - Street 1:4220 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6120
Practice Address - Country:US
Practice Address - Phone:716-695-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6633183500000X
MAPH1000548183500000X
NY071511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist