Provider Demographics
NPI:1306535661
Name:PARK, JI YOON (MD)
Entity type:Individual
Prefix:MR
First Name:JI YOON
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:150, BUHEUNG-RO, , BUCHEON-SI GYEONGGIP-DO, REPUBLIC OF
Mailing Address - Street 2:SARANG APT 1612-1402
Mailing Address - City:BUCHEON-SI
Mailing Address - State:GYEONGGI-DI
Mailing Address - Zip Code:14600
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVENUE SOUTHEAST
Practice Address - Street 2:CAMC MEMORIAL HOSPITAL INTERNAL MEDICINE
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5590
Practice Address - Fax:304-388-8238
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program