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NPI Code Detail

MEDICARE: SUENG K PARK M.D.

MEDICARE: SUENG K PARK M.D.
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
12085R0202XDiagnostic Radiology PhysicianE1917TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
48AN893OTHERTXBCBS

General Provider Information

NPI Number : 1922099902
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUENG K PARK M.D.
Provider Business Mailing Address
First Line : PO BOX 3119
Second Line :
City : HOUSTON
State : TX
Zip : 77253-3119
Country : US
Telephone Number : 713-481-3533
Fax Number : 713-432-0221
Provider Business Practice Location Address
First Line : 4600 E SAM HOUSTON PKWY S
Second Line :
City : PASADENA
State : TX
Zip : 77505-3948
Country : US
Telephone Number : 713-481-3533
Fax Number : 713-432-0221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 12/02/2009

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