Provider Demographics
NPI:1215927280
Name:PARK, KEE JONG (MD)
Entity type:Individual
Prefix:DR
First Name:KEE
Middle Name:JONG
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6196 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3821
Mailing Address - Country:US
Mailing Address - Phone:410-992-5963
Mailing Address - Fax:410-760-8130
Practice Address - Street 1:7845 OAKWOOD RD
Practice Address - Street 2:SUITE 308
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4280
Practice Address - Country:US
Practice Address - Phone:410-760-8131
Practice Address - Fax:410-760-8130
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0018934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics