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General NPI Number Information
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NPI Number | 1861497596
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Entity Type | Individual
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Provider Name | GREGORY PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 N CHURCH ST
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City | WAILUKU
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State | HI
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Zip | 96793-1600
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Country | US
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Telephone | 808-244-7627
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Fax | 808-242-6696
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Provider Business Mailing Address
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Address Line | SEVEN WATERFRONT PLAZA 500 ALA MOANA BLVD., SUITE 300
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone | 808-521-1317
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Fax | 808-533-1482
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD3915
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License Number State | HI
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