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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | PARK TAE KYU MD | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| ID Number | 00152709 | [sources] | |||
| NPI | 1336230259 | [sources] | |||
| Sector | Physician | [sources] | |||
| Status | not available | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers deemed ineligible to participate in New York State's Medicaid program.
United States of America · OMIG
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