Individual
MARK TAE MYUNG INDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8420 UNIVERSITY EXEC PARK DR STE 850, CHARLOTTE, NC 28262-1308
(704) 384-1225
(704) 384-1226
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2021-01061
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2018
Last updated
04/26/2023
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