Healthcare Provider Details

I. General information

NPI: 1053508200
Provider Name (Legal Business Name): SANGAE KIM-PARK, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MEDICAL PARK DR E SUITE 312
BIRMINGHAM AL
35235-3430
US

IV. Provider business mailing address

52 MEDICAL PARK DR E SUITE 312
BIRMINGHAM AL
35235-3430
US

V. Phone/Fax

Practice location:
  • Phone: 205-702-6602
  • Fax: 205-836-3190
Mailing address:
  • Phone: 205-702-6602
  • Fax: 205-836-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28332
License Number StateAL

VIII. Authorized Official

Name: MR. CHULWON PARK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 205-702-6602