Individual
DONG SOO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
485 W MARKET ST, TIFFIN, OH 44883
(419) 447-3130
(419) 447-3155
Mailing address
PO BOX 1108, ANN ARBOR, MI 48106-1108
(734) 677-7400
(734) 677-7407
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35041526P
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000024792
BCBS GROUP PIN
OH
05
—
0359400
—
OH
01
—
9122391
GROUP
OH
01
—
CK3646
MEDICARE RR GROUP PIN
OH
Enumeration date
07/12/2006
Last updated
11/02/2007
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