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General NPI Number Information
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NPI Number | 1215103171
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Entity Type | Individual
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Provider Name | SUNG EUN PARK MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 1505 NW GILMAN BLVD STE 8
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City | ISSAQUAH
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State | WA
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Zip | 98027-5398
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Country | US
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Telephone | 425-357-7082
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Fax | 425-437-5259
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Provider Business Mailing Address
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Address Line | 1505 NW GILMAN BLVD STE 8
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City | ISSAQUAH
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State | WA
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Zip | 98027-5398
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Country | US
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Telephone | 425-357-7082
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Fax | 425-437-5259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 6353386-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD61491409
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036120274
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M11886
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License Number State | ID
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