Provider Demographics
NPI:1134414881
Name:PARK, MIN SOO (DO)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:SOO
Last Name:PARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SHADOW LANE
Mailing Address - Street 2:VALLEY HOSPITAL MEDICAL CENTER
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-388-4000
Mailing Address - Fax:702-388-8431
Practice Address - Street 1:620 SHADOW LANE
Practice Address - Street 2:VALLEY HOSPITAL MEDICAL CENTER
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-388-4000
Practice Address - Fax:702-388-8431
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine