Healthcare Provider Details

I. General information

NPI: 1932028198
Provider Name (Legal Business Name): JUN PARK, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28821 WAGON RD
AGOURA HILLS CA
91301-2733
US

IV. Provider business mailing address

28821 WAGON RD
AGOURA HILLS CA
91301-2733
US

V. Phone/Fax

Practice location:
  • Phone: 323-383-7775
  • Fax:
Mailing address:
  • Phone: 323-383-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUN KYU PARK
Title or Position: PRESIDENT
Credential: MD
Phone: 323-383-7775