Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | X009838 | NY |
NPI | 1235164989 |
---|---|
Provider Name | Sang Ho Park |
First Address | New Hyde Park, NY 11040-8956 |
Second Address | Flushing, NY 11358-2620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 03/02/2022 |