Healthcare Provider Details

I. General information

NPI: 1144305632
Provider Name (Legal Business Name): HAN PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL STREET THE QUEEN'S MEDICAL CENTER - EMERGENCY DEPT.
HONOLULU HI
96813-5212
US

IV. Provider business mailing address

770 KAPIOLANI BLVD SUITE 705
HONOLULU HI
96813-5212
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-4311
  • Fax:
Mailing address:
  • Phone: 808-597-8791
  • Fax: 808-597-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number215206
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD16011
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: