Healthcare Provider Details

I. General information

NPI: 1205974706
Provider Name (Legal Business Name): SO HYANG PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SO HYANG PARK MD

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N READING RD
EPHRATA PA
17522-9606
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-738-4070
  • Fax: 717-738-3558
Mailing address:
  • Phone: 717-721-4840
  • Fax: 717-738-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD062484L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: