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NPI Code Detail

MEDICARE: SONG Y. PARK NP-C

MEDICARE: SONG Y. PARK NP-C
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
1363L00000XNurse PractitionerAP61211573WA
2363LF0000XFamily Nurse PractitionerRN219551GA
3363L00000XNurse Practitioner1185938TX

General Provider Information

NPI Number : 1568852317
Entity Type Code : Individual
Provider Name (Legal Business Name) : SONG Y. PARK NP-C
Provider Business Mailing Address
First Line : 23320 HIGHWAY 99
Second Line :
City : EDMONDS
State : WA
Zip : 98026-8744
Country : US
Telephone Number : 425-640-5500
Fax Number :
Provider Business Practice Location Address
First Line : 8588 KATY FWY STE 226A
Second Line :
City : HOUSTON
State : TX
Zip : 77024-1881
Country : US
Telephone Number : 713-532-6884
Fax Number : 713-532-5756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2015
Last Update Date : 01/23/2025

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Directions to “ SONG Y. PARK NP-C” Practice Location

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