MEDICARE: DR. DANIEL KWANGWON PARK MD

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
1	207X00000X	Orthopaedic Surgery Physician	4301097927	MI
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	036131466	IL

General Provider Information

NPI Number	:	1073769162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL KWANGWON PARK MD

Provider Business Mailing Address
First Line	:	PO BOX 735263
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5263
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 W HARRISON ST STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4861
Country	:	US
Telephone Number	:	877-632-6637
Fax Number	:	708-409-5179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	12/01/2025

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