Doctor Name: | MR. TAESUN PARK |
NPI Number: | 1376763623 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L..AC |
License Number: | 125 |
Business Practice Address: | 5441 Buford Hwy Ne # Suit202 Doraville, GA - 303401124 |
Business Phone Number: | 4044889648 |
Business Fax Number: | |
Mailing Address: | 672 Bridgeton Cove, SUWANEE |
State: | GA |
Postal Code: | 30024 |
Phone Number: | 4044889648 |
Fax Number: | |
NPI Enumeration Date: | 04/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |