Provider Demographics
NPI:1922399351
Name:PARK, JUNG KI (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNG KI
Middle Name:
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 1:185 S ORANGE AVE
Mailing Address - Street 2:MSB E-532
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2757
Mailing Address - Country:US
Mailing Address - Phone:973-972-5482
Mailing Address - Fax:973-972-4574
Practice Address - Street 1:185 S ORANGE AVE
Practice Address - Street 2:MSB E-532
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-5482
Practice Address - Fax:973-972-4574
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183815-1207V00000X
NJ25MA09881800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF21523Medicare PIN