Provider Demographics
NPI:1053393009
Name:PARK, STEVE BYONGKOO (MD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:BYONGKOO
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 BUFFALO RD
Mailing Address - Street 2:BLDG 700
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1360
Mailing Address - Country:US
Mailing Address - Phone:585-328-0153
Mailing Address - Fax:585-328-0158
Practice Address - Street 1:2300 BUFFALO RD
Practice Address - Street 2:BLDG 700
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1360
Practice Address - Country:US
Practice Address - Phone:585-328-0153
Practice Address - Fax:585-328-0158
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1824202207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01445376Medicaid
NY01445376Medicaid
E85050Medicare UPIN