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General NPI Number Information
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NPI Number | 1639220312
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Entity Type | Individual
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Provider Name | HAN Y PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | LOWELL GENERAL HOSPITAL 295 VARUM AVENE
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City | LOWELL
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State | MA
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Zip | 01854
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Country | US
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Telephone | 978-454-0941
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Fax |
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Provider Business Mailing Address
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Address Line | 31 ALGONQUIN AVE
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City | ANDOVER
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State | MA
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Zip | 01810-5527
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Country | US
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Telephone | 978-454-0941
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 56555
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License Number State | MA
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