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General NPI Number Information
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NPI Number | 1881030666
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Entity Type | Organization
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Legal Business Name | JUN KYU PARK, M.D. INC.
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 7300 MEDICAL CENTER DR
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City | WEST HILLS
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State | CA
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Zip | 91307-1902
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Country | US
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Telephone | 818-984-1942
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Fax | 818-786-5417
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Provider Business Mailing Address
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Address Line | 6236 MAMMOTH AVE
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City | VAN NUYS
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State | CA
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Zip | 91401-2936
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Country | US
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Telephone | 818-984-1942
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Fax | 818-786-5417
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUN KYU PARK
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Credential | MD
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Telephone | 818-984-1942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A98074
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License Number State | CA
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