Healthcare Provider Details

I. General information

NPI: 1255336665
Provider Name (Legal Business Name): CHAN H. PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVE PARK M.D.

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 STOCKDALE HWY SUITE 203
BAKERSFIELD CA
93311-3620
US

IV. Provider business mailing address

500 OLD RIVER RD STE 250
BAKERSFIELD CA
93311-9515
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-8110
  • Fax: 661-587-8220
Mailing address:
  • Phone: 661-459-1010
  • Fax: 855-200-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA068509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: