Provider Demographics
NPI:1699894709
Name:PARK, JOON SUNG (MD)
Entity type:Individual
Prefix:DR
First Name:JOON
Middle Name:SUNG
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:521 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3889
Mailing Address - Country:US
Mailing Address - Phone:269-226-2656
Mailing Address - Fax:269-349-7450
Practice Address - Street 1:521 E MICHIGAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3889
Practice Address - Country:US
Practice Address - Phone:269-226-2656
Practice Address - Fax:269-349-7450
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074665207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106318621OtherBCBS INDIVIDUAL
MI0C97618OtherBCBS
MI0C97618OtherBCBS
MIC97618162Medicare PIN
H70388Medicare UPIN