Healthcare Provider Details

I. General information

NPI: 1306185202
Provider Name (Legal Business Name): ZEENITH HYUN PARK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 BOSTON POST RD
DARIEN CT
06820-4717
US

IV. Provider business mailing address

688 BOSTON POST RD
DARIEN CT
06820-4717
US

V. Phone/Fax

Practice location:
  • Phone: 203-662-9602
  • Fax: 203-662-0061
Mailing address:
  • Phone: 203-662-9602
  • Fax: 203-662-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005293
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: