Individual
PAUL PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
219 STATE AVE N STE 100, KENT, WA 98030-4543
(253) 372-3602
Mailing address
955 POWELL AVE SW, RENTON, WA 98057-2908
(425) 277-1311
(425) 277-1566
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD61225125
WA
207R00000X
Internal Medicine Physician
254635
MA
207R00000X
Internal Medicine Physician
Primary
MD61225125
WA
Other
Enumeration date
04/10/2009
Last updated
07/18/2022
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