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General NPI Number Information
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NPI Number | 1013216860
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Entity Type | Individual
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Provider Name | SUNJU PARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 3400 BAINBRIDGE AVE
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City | BRONX
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State | NY
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Zip | 10467
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Country | US
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Telephone | 718-920-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 3332 ROCHAMBEAU AVE FL 3
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City | BRONX
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State | NY
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Zip | 10467-2836
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Country | US
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Telephone | 718-920-5520
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Fax | 718-881-5439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0110X
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Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
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License Number | 292508
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License Number State | NY
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