Basic Information
| Provider Information | |||||||||
| NPI: | 1831365279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | JOON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11721 WHITTIER BLVD | ||||||||
| Address2: | SUITE 509 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906013939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
| FaxNumber: | 5623098200 | ||||||||
| Practice Location | |||||||||
| Address1: | 12401 EAST WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906021006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
| FaxNumber: | 5623098200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 036-118473 | IL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | A107054 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | A107054 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.