Provider Demographics
NPI:1013380641
Name:PARK, HOJUN (OMD)
Entity Type:Individual
Prefix:MR
First Name:HOJUN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 PEACHTREE INDUSTRIAL BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4851
Mailing Address - Country:US
Mailing Address - Phone:404-935-2200
Mailing Address - Fax:
Practice Address - Street 1:3631 PEACHTREE INDUSTRIAL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4851
Practice Address - Country:US
Practice Address - Phone:404-935-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA327171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist