Provider Demographics
NPI:1962232645
Name:PARK, SEJIN (NP)
Entity type:Individual
Prefix:
First Name:SEJIN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 N 3RD ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-4042
Mailing Address - Country:US
Mailing Address - Phone:310-736-0500
Mailing Address - Fax:
Practice Address - Street 1:94 N 3RD ST APT 2N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-4042
Practice Address - Country:US
Practice Address - Phone:310-736-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF40607-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry