Provider Demographics
NPI:1861132318
Name:PARK, BRIDGET SOJUNG
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:SOJUNG
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 OLD MAIN ST APT 1216
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2221
Mailing Address - Country:US
Mailing Address - Phone:202-341-0746
Mailing Address - Fax:
Practice Address - Street 1:1850 OLD MAIN ST APT 1216
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2221
Practice Address - Country:US
Practice Address - Phone:202-341-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program