Healthcare Provider Details

I. General information

NPI: 1316260045
Provider Name (Legal Business Name): SAE JOUN PARK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MITCHELL AVE
BINGHAMTON NY
13903-1617
US

IV. Provider business mailing address

10 MITCHELL AVE
BINGHAMTON NY
13903-1617
US

V. Phone/Fax

Practice location:
  • Phone: 607-762-2020
  • Fax: 607-762-2029
Mailing address:
  • Phone: 607-762-2020
  • Fax: 607-762-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number110896
License Number StateNY

VIII. Authorized Official

Name: DR. SAE JOUN PARK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 607-762-2020