Provider Demographics
NPI:1831296185
Name:PARK, PETER JOONSUN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOONSUN
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 1:3001 CRANBROOK CT
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2209
Mailing Address - Country:US
Mailing Address - Phone:858-535-9651
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR. NAVAL MEDICAL CENTER
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1110
Practice Address - Country:US
Practice Address - Phone:619-532-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37489-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine