Individual
SANGDO PARK
Active
Individual
SANGDO PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A107642
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
N6562
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8CR159
BC/BS TX - EFFECT. 02/01/2011
TX
01
—
8W9051
BCBS
TX
01
—
P00935331
RAILROAD MEDICARE
TX
Enumeration date
12/12/2006
Last updated
10/24/2012
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