Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 63507 | TN |
N | 207YP0228X | Pediatric Otolaryngology | ML.61061354 | WA |
NPI | 1033504196 |
---|---|
Provider Name | Dr. Jason Sun-Hyung Park |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2015 |
Last Update Date | 15/09/2021 |