In Kwon Park Md Pllc | |
8730 S Tacoma Way Ste 104 Lakewood WA 98499-4521 | |
(253) 212-3637 | |
(253) 267-0153 |
Full Name | In Kwon Park Md Pllc |
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Speciality | Internal Medicine |
Location | 8730 S Tacoma Way Ste 104, Lakewood, Washington |
Authorized Official Name and Position | In Kwon Park (MD) |
Authorized Official Contact | 2532123637 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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In Kwon Park Md Pllc 8730 S Tacoma Way Ste 104 Lakewood WA 98499-4521 Ph: (253) 212-3637 | In Kwon Park Md Pllc 8730 S Tacoma Way Ste 104 Lakewood WA 98499-4521 Ph: (253) 212-3637 |
NPI Number | 1417509746 |
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Provider Enumeration Date | 07/16/2019 |
Last Update Date | 07/26/2022 |
Medicare PECOS PAC ID | 8426387093 |
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Medicare Enrollment ID | O20190906001096 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417509746 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Secondary |
Provider Name | In Kwon Park |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1255588679 PECOS PAC ID: 9133280845 Enrollment ID: I20190906001249 |
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