Individual
KIE JUNG PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
562 WYOMING AVE, KINGSTON, PA 18704
(570) 552-3900
(570) 552-3907
Mailing address
6 REVERE RD, MOUNTAIN TOP, PA 18707
(570) 552-3900
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD033477L
PA
2084P0802X
Addiction Psychiatry Physician
MD033477L
PA
2084P0805X
Geriatric Psychiatry Physician
MD033477L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007338991
—
PA
Enumeration date
06/13/2006
Last updated
10/02/2009
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