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NPI Code Detail

MEDICARE: DANIEL JUN PARK M.D.

MEDICARE: DANIEL JUN PARK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianS0046TX

General Provider Information

NPI Number : 1063875292
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL JUN PARK M.D.
Provider Business Mailing Address
First Line : 8288 S BROADWAY AVE
Second Line :
City : TYLER
State : TX
Zip : 75703-5262
Country : US
Telephone Number : 903-606-7060
Fax Number : 903-606-7129
Provider Business Practice Location Address
First Line : 8288 S BROADWAY AVE
Second Line :
City : TYLER
State : TX
Zip : 75703-5262
Country : US
Telephone Number : 903-606-7060
Fax Number : 903-606-7129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2016
Last Update Date : 03/17/2026

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