Provider Demographics
NPI:1487623278
Name:PARK, HANBYUL WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:HANBYUL
Middle Name:WILLIAM
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 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:280 SMITH AVE N STE 500
Practice Address - Street 2:SUITE 307
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2463
Practice Address - Country:US
Practice Address - Phone:651-968-5420
Practice Address - Fax:651-222-0956
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22415207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0978981Medicaid
MN200031316OtherRAILROAD MEDICARE
MN200001364Medicare PIN
MN200031316OtherRAILROAD MEDICARE