Healthcare Provider Details

I. General information

NPI: 1215176573
Provider Name (Legal Business Name): CHRISTINE CHUNGHEE KUNATH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE CHUNGHEE PARK DO

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 OAKWOOD BLVD
DEARBORN MI
48124-2319
US

IV. Provider business mailing address

840 OAKWOOD BLVD
DEARBORN MI
48124-2319
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-7600
  • Fax: 313-359-7678
Mailing address:
  • Phone: 313-359-7600
  • Fax: 313-359-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number5101015987
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101015987
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: