Provider Demographics
NPI:1598866162
Name:PARK, EUN-JUNG (MD)
Entity Type:Individual
Prefix:
First Name:EUN-JUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EUN-JUNG
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:60 GARDEN CT
Mailing Address - Street 2:STE 310
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5370
Mailing Address - Country:US
Mailing Address - Phone:831-647-3192
Mailing Address - Fax:831-642-9133
Practice Address - Street 1:60 GARDEN CT
Practice Address - Street 2:STE 310
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5370
Practice Address - Country:US
Practice Address - Phone:831-647-3192
Practice Address - Fax:831-642-9133
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A660340Medicaid
00A660340Medicare ID - Type Unspecified
CA00A660340Medicaid