Individual
SEOUNG SOU PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 STEVENS AVENUE, SUITE 310, MOUNT VERNON, NY 10550-2686
(914) 663-6635
(914) 663-6637
Mailing address
105 STEVENS AVENUE, SUITE 310, MOUNT VERNON, NY 10550-2686
(914) 663-6635
(914) 663-6637
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
197192
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01729675
—
NY
01
—
21N461
EMPIRE BCBS
NY
01
—
7464117
AETNA
—
01
—
P1229667
OXFORD HEALTH PLAN
—
Enumeration date
02/13/2007
Last updated
07/08/2007
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