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General NPI Number Information
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NPI Number | 1679815898
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Entity Type | Individual
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Provider Name | HANNA PARK MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 12/05/2021
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Provider Practice Location Address
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Address Line | 100 MICHIGAN ST NE RM 8830
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-459-7258
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Fax |
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Provider Business Mailing Address
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Address Line | 9961 SIERRA AVE ATTN: CARDIAC SURGERY
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City | FONTANA
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State | CA
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Zip | 92335
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Country | US
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Telephone | 909-427-3615
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | A133676
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 4301116177
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License Number State | MI
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