Healthcare Provider Details

I. General information

NPI: 1336893429
Provider Name (Legal Business Name): JOSEPH PARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOE PARK MD

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HEALTHCARE OPS SQUADRON FFM 130
OSAN AB KOREA
96278
KR

IV. Provider business mailing address

51 MEDICAL GROUP UNIT 2060
APO AP
96278
KR

V. Phone/Fax

Practice location:
  • Phone: 315-784-2552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number99041
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: