Park, Kwang-Soo
Park, Kwang-Soo is an individual health care provider with primary practice located at 6915 Tutt Blvd Ste 110B , Colorado Springs CO 80923. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Geriatric Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Park, Kwang-Soo can be contacted via phone (719) 445-1292.Contact Information
Primary practice address
6915 Tutt Blvd Ste 110B
Colorado Springs CO 80923
Phone: (719) 445-1292
Fax: (719) 591-6486
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 0060675 | Colorado |
| Allopathic & Osteopathic Physicians / Geriatric Psychiatry | 2084P0805X | DR0060675 | Colorado |
Profile Details
| NPI number | 1689635880 |
|---|---|
| LBN Legal business name | Park, Kwang-Soo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 29th, 2006 |
| Last updated | Jul 30th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1689635880 | NPPES |
| Ohio | MEDICAID | 2334978 | |
| Ohio | MEDICAID | 1840930000 |
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