Park, Jung Tae
Park, Jung Tae is an sole proprietor health care provider with primary practice located at 13851 Highway 28 , Whitwell TN 37397-5373. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as his primary health care specialty. Park, Jung Tae can be contacted via phone (423) 658-9200.Contact Information
Primary practice address
13851 Highway 28
Whitwell TN 37397-5373
Phone: (423) 658-9200
Fax: (423) 658-2195
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adult Medicine | 207QA0505X | MD0000010100 | Tennessee |
Profile Details
| NPI number | 1942291638 |
|---|---|
| LBN Legal business name | Park, Jung Tae |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 2nd, 2005 |
| Last updated | Dec 14th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1942291638 | NPPES |
| Tennessee | Other | 2002139 | B CARE |
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