Healthcare Provider Details

I. General information

NPI: 1730982851
Provider Name (Legal Business Name): SEHYUN PARK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 REYNOLDS ST STE 100
MONROE NC
28112-4376
US

IV. Provider business mailing address

1623 CANDLEWOOD RIDGE LN
MATTHEWS NC
28105-3211
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-5443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: