Provider Demographics
NPI:1437365814
Name:PARK, JAE K (MD)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:K
Last Name:PARK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6185 BUFORD HWY
Mailing Address - Street 2:SUITE B-104
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2350
Mailing Address - Country:US
Mailing Address - Phone:770-416-0099
Mailing Address - Fax:770-416-0022
Practice Address - Street 1:6185 BUFORD HWY
Practice Address - Street 2:SUITE B-104
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2350
Practice Address - Country:US
Practice Address - Phone:770-416-0099
Practice Address - Fax:770-416-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA030177207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology