| Stefanie Park MD LLC | |
|
347 N Kuakini St Honolulu HI 96817-2336 | |
| (808) 536-0300 | |
| (808) 536-0320 |
| Full Name | Stefanie Park MD LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 347 N Kuakini St, Honolulu, Hawaii |
| Authorized Official Name and Position | Stefanie M Park (OWNER) |
| Authorized Official Contact | 8087531686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stefanie Park MD LLC Po Box 25490 Honolulu HI 96825-0490 Ph: (808) 536-0314 | Stefanie Park MD LLC 347 N Kuakini St Honolulu HI 96817-2336 Ph: (808) 536-0300 |
| NPI Number | 1598984403 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 10/11/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598984403 | NPI | - | NPPES |
| 594300 | Medicaid | HI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 14109 (Hawaii) | Primary |
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