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General NPI Number Information
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NPI Number | 1306535661
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Entity Type | Individual
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Provider Name | JI YOON PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 3200 MACCORKLE AVENUE SOUTHEAST CAMC MEMORIAL HOSPITAL INTERNAL MEDICINE
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City | CHARLESTON
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State | WV
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Zip | 25304
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Country | US
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Telephone | 304-388-5590
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Fax | 304-388-8238
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Provider Business Mailing Address
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Address Line | 150, BUHEUNG-RO, , BUCHEON-SI GYEONGGIP-DO, REPUBLIC OF SARANG APT 1612-1402
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City | BUCHEON-SI
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State | GYEONGGI-DI
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Zip | 14600
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Country | KR
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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