Provider Demographics
NPI:1215103171
Name:PARK, SUNG EUN (MD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:EUN
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 NW GILMAN BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5398
Mailing Address - Country:US
Mailing Address - Phone:425-357-7082
Mailing Address - Fax:425-437-5259
Practice Address - Street 1:1505 NW GILMAN BLVD STE 8
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5398
Practice Address - Country:US
Practice Address - Phone:425-357-7082
Practice Address - Fax:425-437-5259
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6353386-1205208000000X
WAMD61491409208000000X
IL036120274208000000X
IDM11886208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics