MEDICARE: MIN JUNG PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	019426	NY
2	225X00000X	Occupational Therapist	OT70040930	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437538550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIN JUNG PARK

Provider Business Mailing Address
First Line	:	7320 216TH ST SW STE 320
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-8006
Country	:	US
Telephone Number	:	425-673-3916
Fax Number	:	425-673-3926

Provider Business Practice Location Address
First Line	:	7320 216TH ST SW STE 320
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-8006
Country	:	US
Telephone Number	:	425-673-3916
Fax Number	:	425-673-3926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	03/16/2026

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Practice Location Address:

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1508865429 — DAVID K KUECHLE MD
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1700886157 — NANCY B ISENBERG MD
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Directions to “ MIN JUNG PARK ” Practice Location

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