| Doctor Name: | MR. JUNG TAE PARK |
| NPI Number: | 1942291638 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD0000010100 |
| Business Practice Address: | 13851 Highway 28 Whitwell, TN - 373975373 |
| Business Phone Number: | 4236589200 |
| Business Fax Number: | 4236582195 |
| Mailing Address: | Po Box 400, 13851 Highway 28 WHITWELL |
| State: | TN |
| Postal Code: | 373970400 |
| Phone Number: | 4236589200 |
| Fax Number: | 4236582195 |
| NPI Enumeration Date: | 11/02/2005 |
| NPI Last Update Date: | 11/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | MD0000010100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |