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

SE Hun Park, ATC

Individual provider Athletic Trainer · NPI 1356717789

SE Hun Park, ATC is a Physician Assistant in Lawton, Oklahoma. Qualified in 2023, 3 years ago. Practices with Ies ER Oklahoma LLC, a 128-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
3
Licensed in
MO
In the registry since
2015
Specialties on file
2
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

3401 W Gore Blvd
Lawton, OK 73505-6332
Phone: (580) 355-8620
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Athletic Trainer Taxonomy 2255A2300X · Licence 2015022932 (MO)

Record details

NPI number1356717789
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC
Sole proprietorNo
NPI enumeratedAugust 19, 2015
Last updated in NPPESDecember 20, 2024
Certification dateDecember 20, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Ies Er Oklahoma Llc — 128 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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