Basic Information
| Provider Information | |||||||||
| NPI: | 1275029084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | JINWOOK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 SPRUCE STREET | ||||||||
| Address2: | RENAL OFFICES, 1 FOUNDERS | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 SPRUCE STREET | ||||||||
| Address2: | RENAL OFFICES, 1 FOUNDERS | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156622638 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2018 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57.245872 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MT224405 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.