Provider Demographics
NPI:1033405840
Name:PARK, JEEYOON (MD)
Entity Type:Individual
Prefix:
First Name:JEEYOON
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1880
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3139
Mailing Address - Country:US
Mailing Address - Phone:312-642-9844
Mailing Address - Fax:312-642-7637
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1880
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3139
Practice Address - Country:US
Practice Address - Phone:312-642-9844
Practice Address - Fax:312-642-7637
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060208207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology