Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R73284 | AZ |
N | 111NI0900X | Internist | R73284 | AZ |
Y | 207RH0003X | Hematology & Oncology | 56234 | AZ |
N | 207RH0003X | Hematology & Oncology | R6867 | TX |
N | 207RH0003X | Hematology & Oncology | R73284 | AZ |
NPI | 1013279256 |
---|---|
Provider Name | Soyoung Park |
First Address | Tucson, AZ 85718-5999 |
Second Address | Scottsdale, AZ 85258-4547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 11/11/2020 |