Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 0036-082295 | IL |
NPI | 1013903491 |
---|---|
Provider Name | Chinyoung Park |
First Address | Des Plaines, IL 60016-2359 |
Second Address | Morton Grove, IL 60053-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 10/03/2017 |