Provider Demographics
NPI:1194083154
Name:PARK, KYUNG (MD)
Entity type:Individual
Prefix:
First Name:KYUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:2F
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3009
Mailing Address - Country:US
Mailing Address - Phone:213-718-6814
Mailing Address - Fax:
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:2F
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901
Practice Address - Country:US
Practice Address - Phone:213-718-6814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283588207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology