Individual
TAEHYUN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
4115 45TH ST APT 3J, SUNNYSIDE, NY 11104-1922
(917) 714-8916
Mailing address
4115 45TH ST APT 3J, SUNNYSIDE, NY 11104-1922
(917) 714-8916
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F402603
NY
Other
Enumeration date
06/07/2019
Last updated
06/07/2019
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