Sung Eun Park, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD61491409 Issued in WA

Practice address

1505 NW Gilman Blvd Ste 8
Issaquah, WA 98027-5398

Phone

(425) 357-7082

Fax

(425) 437-5259

NPI assigned

May 1, 2008

Last updated

Sep 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Pediatric Medicine PLLC

  dba Lighthouse Pediatrics

  • Pediatrics Physician
  • Issaquah, WA
  • NPI 1336967611
  NPD Authorized official
• Lakeside Pediatric & Adolescent Medicine, PLLC

  • Pediatric Adolescent Medicine Physician
  • Coeur d'Alene, ID
  • NPI 1003975087
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1215103171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 NW GILMAN BLVD STE 8",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275398",
            "telephone_number": "425-357-7082",
            "fax_number": "425-437-5259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NW GILMAN BLVD STE 8",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275398",
            "telephone_number": "425-357-7082",
            "fax_number": "425-437-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUNG",
        "middle_name": "EUN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-01",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "6353386-1205",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD61491409",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036120274",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M11886",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gena Palm
• Brenda Lee Palmiotto, PT
• Alexander Lite Pan, MD
• Alexandra Lyn Panos
• Jessica Ann Pare, MPT, OCS
• Catyann Ikuko Parker, PT, DPT
• Xylie Parker, OTR/L
• John William Parmelee, DPM
• Jordan Parrick, L.M.P
• Todd A Parsons, ATC

• Pediatrics Physician in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.