Individual
JOON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
269 PORTLAND WAY S, GALION, OH 44833-2312
(419) 468-0708
Mailing address
5620 SOUTHWYCK BLVD, TOLEDO, OH 43614-1501
(800) 288-8325
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
35058117
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000125977
ANTHEM
OH
05
—
0742781
—
OH
Enumeration date
09/14/2005
Last updated
07/08/2007
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