Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036121570 | IL |
N | 2086S0122X | Plastic and Reconstructive Surgery | P9592 | MD |
NPI | 1316084593 |
---|---|
Provider Name | Dr. Julie Eunnah Park |
First Address | Chicago, IL 60637-1470 |
Second Address | Chicago, IL 60637-1470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 29/04/2009 |