Provider Demographics
NPI:1124845193
Name:PARK, ZU WON (PA-C)
Entity type:Individual
Prefix:MS
First Name:ZU
Middle Name:WON
Last Name:PARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27655 MIDDLEBELT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5029
Mailing Address - Country:US
Mailing Address - Phone:248-363-3232
Mailing Address - Fax:
Practice Address - Street 1:27655 MIDDLEBELT RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5029
Practice Address - Country:US
Practice Address - Phone:248-363-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601012792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant