Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 115322 | NY |
NPI | 1124263330 |
---|---|
Provider Name | Mr. Eung Whan Park |
First Address | Staten Island, NY 10304 |
Second Address | Ny, NY 10304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2008 |
Last Update Date | 03/12/2008 |