Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01026154A | IN |
N | 111NI0900X | Internist | 01026154A | IN |
Y | 207U00000X | Nuclear Medicine Specialist | 01026154A | IN |
NPI | 1508197161 |
---|---|
Provider Name | Dr. Hee Myung Park |
First Address | Indianapolis, IN 46256-2288 |
Second Address | Indianapolis, IN 46256-2288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2010 |
Last Update Date | 21/01/2010 |