Individual
DANIEL S PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 BRULE ST BLDG 871, FORT KNOX, KY 40121-6100
(502) 624-9333
Mailing address
1166 NE LAUREL CT, ISSAQUAH, WA 98029-7676
(206) 778-9459
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1204605
NCCPA IDENTIFICATION NUMBER
—
Enumeration date
12/27/2022
Last updated
12/27/2022
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