Individual
KWANG-SOO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6915 TUTT BLVD STE 110B, COLORADO SPRINGS, CO 80923
(719) 445-1292
(719) 591-6486
Mailing address
1065 NE 125TH ST STE 409, NORTH MIAMI, FL 33161-5834
(888) 852-6672
(877) 720-0502
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0060675
CO
2084P0805X
Geriatric Psychiatry Physician
DR0060675
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1840930000
—
WV
05
—
2334978
—
OH
Enumeration date
03/29/2006
Last updated
07/30/2018
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