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NPI Code Detail

MEDICARE: DR. SOHEE KIM PARK DMD, MHS

MEDICARE: DR. SOHEE KIM PARK DMD, MHS
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
11223P0300XPeriodontics3592SC

Other Identifiers

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

General Provider Information

NPI Number : 1700800497
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SOHEE KIM PARK DMD, MHS
Provider Business Mailing Address
First Line : 456 CLEMSON RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-7925
Country : US
Telephone Number : 803-788-9715
Fax Number : 803-788-9705
Provider Business Practice Location Address
First Line : 456 CLEMSON RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-7925
Country : US
Telephone Number : 803-788-9715
Fax Number : 803-788-9705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 03/27/2019

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