Individual
DAVID JUNEWON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1825 EASTCHESTER RD, BRONX, NY 10461-2301
(718) 904-2000
Mailing address
5235 BUFORD HWY NE, DORAVILLE, GA 30340-1106
(404) 717-9051
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1140276
—
363A00000X
Physician Assistant
8743
GA
363AM0700X
Medical Physician Assistant
Primary
024237
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1140276
NCCPA PA LICENSE NUMBER
—
01
—
8743
GEORGIA PA LICENSE NUMBER
GA
Enumeration date
04/09/2018
Last updated
10/20/2020
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