Individual
DR. CLINTON SANGKYU PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S HENDERSON ST STE 200, FORT WORTH, TX 76104-2154
(817) 413-1500
(817) 413-1499
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
N3228
TX
2085R0203X
Therapeutic Radiology Physician
BP10022820
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202476201
—
TX
05
—
202476202
—
TX
01
—
8CA240
BLUECROSS BLUESHIELD OF TEXAS
TX
01
—
P00764078
RAILROAD MEDICARE
TX
Enumeration date
07/02/2007
Last updated
12/09/2021
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