Healthcare Provider Details

I. General information

NPI: 1689312530
Provider Name (Legal Business Name): SUNWOO PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OSLER DR
TOWSON MD
21204-7700
US

IV. Provider business mailing address

727 W 40TH ST APT 629
BALTIMORE MD
21211-2358
US

V. Phone/Fax

Practice location:
  • Phone: 141-033-7100
  • Fax:
Mailing address:
  • Phone: 202-679-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0107138
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: