MEDICARE: MINSOO PARK

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1689930950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINSOO PARK

Provider Business Mailing Address
First Line	:	2505 LEACH DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 LEACH DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8907
Country	:	US
Telephone Number	:	913-226-2915
Fax Number	:

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

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	07/31/2025

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Directions to “ MINSOO PARK ” Practice Location

Language	Start Address	Practice Location

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