Healthcare Provider Details

I. General information

NPI: 1861322299
Provider Name (Legal Business Name): HWAJIN PARK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S COLORADO BLVD STE C100
DENVER CO
80222-3358
US

IV. Provider business mailing address

2695 S HIGH ST
DENVER CO
80210-5936
US

V. Phone/Fax

Practice location:
  • Phone: 303-756-9052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: