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General NPI Number Information
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NPI Number | 1700834777
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Entity Type | Individual
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Provider Name | JUNG K PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11209 N TATUM BLVD SUITE #110
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City | PHOENIX
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State | AZ
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Zip | 85028-3091
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Country | US
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Telephone | 602-248-8002
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Fax | 602-248-8399
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Provider Business Mailing Address
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Address Line | PO BOX 14687
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City | SCOTTSDALE
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State | AZ
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Zip | 85267-4687
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Country | US
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Telephone | 480-991-8100
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Fax | 480-922-1028
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 26466
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | F91378
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License Number State | AZ
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