Provider Demographics
NPI:1518599240
Name:PARK, JONGHUN (NP)
Entity Type:Individual
Prefix:MR
First Name:JONGHUN
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST., STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-486-8000
Mailing Address - Fax:713-486-8088
Practice Address - Street 1:6400 FANNIN ST., STE 2800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1534
Practice Address - Country:US
Practice Address - Phone:713-486-8000
Practice Address - Fax:713-486-8088
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145158363LA2100X
TX815253163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience