Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME146480 | FL |
NPI | 1003158767 |
---|---|
Provider Name | Dr. Minnsun Koh Park |
First Address | Jacksonville, FL 32216-4331 |
Second Address | Jacksonville, FL 32216-4331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 31/07/2020 |