MEDICARE: SANGKUN PARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD18585	OR
2	2471B0102X	Bone Densitometry Radiologic Technologist
3	2471C3402X	Radiography Radiologic Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477622991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANGKUN PARK MD

Provider Business Mailing Address
First Line	:	2120 EXCHANGE ST
Second Line	:	STE 200
City	:	ASTORIA
State	:	OR
Zip	:	97103-3364
Country	:	US
Telephone Number	:	503-325-5360
Fax Number	:	503-325-9373

Provider Business Practice Location Address
First Line	:	2120 EXCHANGE ST
Second Line	:	STE 200
City	:	ASTORIA
State	:	OR
Zip	:	97103-3364
Country	:	US
Telephone Number	:	503-325-5360
Fax Number	:	503-325-9373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/25/2009

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Directions to “ SANGKUN PARK MD” Practice Location

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