Individual
DR. JUN TAE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
35-097398
OH
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
5922577-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0063239
—
OH
Enumeration date
12/24/2007
Last updated
05/29/2013
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