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General NPI Number Information
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NPI Number | 1497744502
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Entity Type | Individual
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Provider Name | RAYMOND D.H. PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 12303 NE 130TH LN SUITE 325
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City | KIRKLAND
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State | WA
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Zip | 98034-3099
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Country | US
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Telephone | 425-899-3135
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Fax | 425-899-3143
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Provider Business Mailing Address
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Address Line | PO BOX 69737
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City | SEATTLE
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State | WA
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Zip | 98168-8737
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Country | US
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Telephone | 206-431-0138
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Fax | 206-246-5819
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD00035685
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License Number State | WA
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