Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036.156389 | IL |
N | 207N00000X | Dermatologist | 1285088302 | IL |
N | 207ND0101X | MOHS-Micrographic Surgeon | 036.156389 | IL |
N | 207ND0101X | MOHS-Micrographic Surgeon | 1285088302 | IL |
NPI | 1285088302 |
---|---|
Provider Name | June Park |
First Address | Naperville, IL 60563-1266 |
Second Address | Naperville, IL 60563-1266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 20/12/2021 |