Healthcare Provider Details

I. General information

NPI: 1265927321
Provider Name (Legal Business Name): SAE-YOON SHARON PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BOX HILL CORPORATE CENTER DR STE 100
ABINGDON MD
21009-1290
US

IV. Provider business mailing address

3400 BOX HILL CORPORATE CENTER DR STE 100
ABINGDON MD
21009-1290
US

V. Phone/Fax

Practice location:
  • Phone: 800-777-7904
  • Fax:
Mailing address:
  • Phone: 410-515-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD92535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: