Healthcare Provider Details

I. General information

NPI: 1447563366
Provider Name (Legal Business Name): EUN JOO PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-1239
US

IV. Provider business mailing address

17310 BUCKTHORN DR
CHAGRIN FALLS OH
44023-1412
US

V. Phone/Fax

Practice location:
  • Phone: 216-538-5686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.144300
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01080678A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01080678A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01080678A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: