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Individual

DR. KYE SOO PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 397-3370
(360) 604-1749
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 397-3370
(360) 604-1749

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2004-0437
NM
207RR0500X
Rheumatology Physician
Primary
MD60145123
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0262973
L & I
WA
05
1043359037
WA
Enumeration date
02/06/2007
Last updated
09/22/2010
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