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General NPI Number Information
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NPI Number | 1760864037
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Entity Type | Individual
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Provider Name | MICHAEL JUNG HOON PARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 101 NICHOLLS ROAD HSC T-16 SUITE 030
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City | STONY BROOK
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State | NY
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Zip | 11794-1126
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Country | US
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Telephone | 631-638-4464
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Fax |
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Provider Business Mailing Address
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Address Line | 23 MELBOURNE RD
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City | GREAT NECK
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State | NY
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Zip | 11021-4636
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Country | US
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Telephone | 917-747-9090
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 293472
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 293472
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License Number State | NY
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