Healthcare Provider Details

I. General information

NPI: 1780760132
Provider Name (Legal Business Name): HO-HYUN PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HO H. PARK M.D.

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PLYMOUTH RD SUITE 106
PLYMOUTH MEETING PA
19462-1638
US

IV. Provider business mailing address

1322 SUSQUEHANNA RD
RYDAL PA
19046-1827
US

V. Phone/Fax

Practice location:
  • Phone: 610-941-3390
  • Fax: 610-941-3391
Mailing address:
  • Phone: 215-572-5404
  • Fax: 215-572-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD-031306-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: