Healthcare Provider Details

I. General information

NPI: 1215168109
Provider Name (Legal Business Name): JOHN HO PARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 CLAY EDWARDS DR LOWR LEVEL
NORTH KANSAS CITY MO
64116-3237
US

IV. Provider business mailing address

9411 N OAK TRFY STE LL1
KANSAS CITY MO
64155-2262
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-5216
  • Fax: 816-346-7869
Mailing address:
  • Phone: 816-691-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2024022382
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number94-07228
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: