Healthcare Provider Details

I. General information

NPI: 1477354959
Provider Name (Legal Business Name): HYUNG JOO PARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

55 WILDING CHASE
CHAGRIN FALLS OH
44022-2500
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number75.000080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: