Provider Demographics
NPI:1871352690
Name:PARK, EUNNIE CHUNG
Entity type:Individual
Prefix:
First Name:EUNNIE
Middle Name:CHUNG
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EUN
Other - Middle Name:HEE
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 MILWAUKEE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3878
Mailing Address - Country:US
Mailing Address - Phone:773-715-7505
Mailing Address - Fax:
Practice Address - Street 1:615 MILWAUKEE AVE STE 3
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3878
Practice Address - Country:US
Practice Address - Phone:773-715-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty