Provider Demographics
NPI:1730441544
Name:PARK, HENRY SOO-MIN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:SOO-MIN
Last Name:PARK
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Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:35 PARK ST
Mailing Address - Street 2:SMILOW CANCER HOSPITAL, LL510
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1110
Mailing Address - Country:US
Mailing Address - Phone:203-200-2100
Mailing Address - Fax:203-785-4622
Practice Address - Street 1:35 PARK ST
Practice Address - Street 2:SMILOW CANCER HOSPITAL, LL510
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1110
Practice Address - Country:US
Practice Address - Phone:203-200-2100
Practice Address - Fax:203-785-4622
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT53417390200000X
CT0534172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program