Individual
LYDIA S. PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2529 NE 139TH ST STE 110, VANCOUVER, WA 98686-2719
(360) 882-2778
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
(845) 703-6297
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
278095
NY
207R00000X
Internal Medicine Physician
Primary
OP61202686
WA
208000000X
Pediatrics Physician
278095
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2201200
—
WA
Enumeration date
05/27/2011
Last updated
03/02/2023
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