Provider Demographics
NPI:1700865052
Name:PARK, DONG JUN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DONG JUN
Middle Name:JOHN
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 NEWPORT CENTER DR STE 170
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0937
Mailing Address - Country:US
Mailing Address - Phone:949-777-6883
Mailing Address - Fax:949-629-4011
Practice Address - Street 1:180 NEWPORT CENTER DR STE 170
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0937
Practice Address - Country:US
Practice Address - Phone:949-777-6883
Practice Address - Fax:949-629-4011
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98835208200000X, 207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery