Provider Demographics
NPI:1316084593
Name:PARK, JULIE EUNNAH (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:EUNNAH
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 6035
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1470
Mailing Address - Country:US
Mailing Address - Phone:773-702-6302
Mailing Address - Fax:773-702-1634
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 6035
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1470
Practice Address - Country:US
Practice Address - Phone:773-702-6302
Practice Address - Fax:773-702-1634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP95922086S0122X
IL0361215702086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery