Provider Demographics
NPI:1326542549
Name:PARK, JUNSUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:JUNSUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JUN SUNG
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:42 W 38TH ST RM 1204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-0054
Mailing Address - Country:US
Mailing Address - Phone:212-320-3722
Mailing Address - Fax:212-320-3729
Practice Address - Street 1:42 W 38TH ST RM 1204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-0054
Practice Address - Country:US
Practice Address - Phone:212-320-3722
Practice Address - Fax:212-320-3729
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013030-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty