# DERIC MINWOO PARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1730391509
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084D0003X | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician | 25MA11934400 | NJ | Yes |
| 2084D0003X | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician | MD431575 | PA | — |
| 2084N0400X | Neurology Physician | 0101247111 | VA | — |
| 2084N0400X | Neurology Physician | 036147170 | IL | — |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 09/17/2024