Individual
DR. ANDREW EUNKOO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17051 DALLAS PKWY, SUITE 400, ADDISON, TX 75001-7109
(214) 370-3006
(214) 828-1379
Mailing address
17051 DALLAS PKWY, SUITE 400, ADDISON, TX 75001-7109
(214) 370-3535
(214) 370-0004
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
L6562
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00954841A
—
TX
05
—
159521701
—
TX
05
—
159521702
—
TX
01
—
8810M3
BLUE CROSS PIN
TX
01
—
P00714233
RAIL ROAD MEDICARE PIN
TX
Enumeration date
05/01/2006
Last updated
06/15/2022
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