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General NPI Number Information
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NPI Number | 1336339548
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Entity Type | Organization
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Legal Business Name | PARK & ASSOC S C
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 410 DEWEY STREET
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City | WIS RAPIDS
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State | WI
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Zip | 54494
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Country | US
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Telephone | 715-423-9170
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Fax | 715-325-1874
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Provider Business Mailing Address
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Address Line | PO BOX 203
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54495-0203
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Country | US
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Telephone | 715-423-9170
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Fax | 715-325-1874
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Authorized Official
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Title or Position | PRESIDENT
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Name | HI YOUNG HONG
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Credential | M.D.
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Telephone | 715-423-9170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | WI
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