Healthcare Provider Details

I. General information

NPI: 1205875986
Provider Name (Legal Business Name): MYUNG HEE PARK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 302
TACOMA WA
98405-5305
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 302
TACOMA WA
98405-5305
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-1244
  • Fax: 253-274-7993
Mailing address:
  • Phone: 253-627-1244
  • Fax: 253-274-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60931616
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD63218
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberQ4238
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberD63218
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD60931616
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: