Provider Demographics
NPI:1184639650
Name:PARK, JOO-HEE G (DO)
Entity Type:Individual
Prefix:
First Name:JOO-HEE
Middle Name:G
Last Name:PARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:
Practice Address - Street 1:PMG PROVIDER RESOURCE GROUP
Practice Address - Street 2:2501 BUENA VISTA
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87125
Practice Address - Country:US
Practice Address - Phone:505-923-5327
Practice Address - Fax:505-923-5305
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1310-05207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55338551Medicaid
H99393Medicare UPIN
343727401Medicare PIN