Provider Demographics
NPI:1255606455
Name:DONGSOON PARK,D.C,P.C.
Entity type:Organization
Organization Name:DONGSOON PARK,D.C,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG
Authorized Official - Middle Name:SOON
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-209-3619
Mailing Address - Street 1:4569 PARSONS BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2253
Mailing Address - Country:US
Mailing Address - Phone:563-209-3619
Mailing Address - Fax:
Practice Address - Street 1:7003 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1103
Practice Address - Country:US
Practice Address - Phone:718-333-5603
Practice Address - Fax:718-333-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011699-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty