Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kwangja Park

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1548683691

Kwangja Park is a Student in an Organized Health Care Education/Training Program in Bayside, New York. Licensed in New York. Registered with an NPI since 2014.

Licensed in
NY
In the registry since
2014

Practice location Address checks out

4612 204th St
Bayside, NY 11361-3139
Phone: (646) 823-4472
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence 578436 (NY)

Record details

NPI number1548683691
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 27, 2014
Last updated in NPPESJanuary 27, 2014
Mailing address4612 204th St, Bayside, NY 11361-3139

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