Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD60931616 | WA |
N | 207RC0000X | Internist - Cardiovascular Disease | D63218 | MD |
N | 207RC0000X | Internist - Cardiovascular Disease | MD60931616 | WA |
N | 207RC0000X | Internist - Cardiovascular Disease | Q4238 | TX |
N | 207RI0011X | Interventional Cardiology | D63218 | MD |
NPI | 1205875986 |
---|---|
Provider Name | Dr. Myung Hee Park |
First Address | Tacoma, WA 98405-5305 |
Second Address | Tacoma, WA 98405-5305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2130874 | (05) | WA |
349207601 | (05) | TX |
408288500 | (05) | MD |
647078-01 | BLUE CROSS/BLUE SHIELD (01) | MD |
8FC783 | BLUE CROSS BLUE SHIELD (01) | TX |
G18615 | (02) |