Provider Demographics
NPI:1881626224
Name:PARK, JOON IL (MD)
Entity type:Individual
Prefix:MR
First Name:JOON
Middle Name:IL
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8830 LONG POINT
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055
Mailing Address - Country:US
Mailing Address - Phone:713-464-9494
Mailing Address - Fax:713-464-8477
Practice Address - Street 1:8830 LONG POINT
Practice Address - Street 2:SUITE 402
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-464-9494
Practice Address - Fax:713-464-8477
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SX96Medicare ID - Type Unspecified
C20182Medicare UPIN