MEDICARE: DR. JASON A PARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A62812	CA

General Provider Information

NPI Number	:	1184608481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON A PARK M.D.

Provider Business Mailing Address
First Line	:	1111 EXPOSITION BLVD BLDG 400 SUITE A
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4314
Country	:	US
Telephone Number	:	916-813-5557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 EXPOSITION BLVD BLDG 400 SUITE A
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4314
Country	:	US
Telephone Number	:	916-813-5557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	11/03/2021

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Directions to “ DR. JASON A PARK M.D.” Practice Location

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