Healthcare Provider Details

I. General information

NPI: 1447956115
Provider Name (Legal Business Name): TMS STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY STE 420
LONE TREE CO
80124-5536
US

IV. Provider business mailing address

10099 RIDGEGATE PKWY STE 420
LONE TREE CO
80124-5536
US

V. Phone/Fax

Practice location:
  • Phone: 303-800-6463
  • Fax: 303-500-6585
Mailing address:
  • Phone: 303-800-6463
  • Fax: 303-500-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HY GIA PARK
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 720-209-8537