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General NPI Number Information
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NPI Number | 1699502260
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Entity Type | Individual
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Provider Name | JUNG EUN PARK
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Gender | Female
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 520 W FAYETTE ST APT 406
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City | BALTIMORE
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State | MD
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Zip | 21201-1781
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Country | US
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Telephone | 443-812-6692
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 HIGHPOINT TRL
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City | LAUREL
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State | MD
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Zip | 20707-6508
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Country | US
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Telephone | 443-812-6692
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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