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General NPI Number Information
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NPI Number | 1487316550
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Entity Type | Individual
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Provider Name | KYUNG CHOON PARK O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 6000 PHYSICIANS BLVD
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City | BAKERSFIELD
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State | CA
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Zip | 93301-5840
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Country | US
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Telephone | 661-327-4499
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Fax |
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Provider Business Mailing Address
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Address Line | 11205 STRATHAVEN ST
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City | BAKERSFIELD
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State | CA
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Zip | 93312-7016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1114
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 35135
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License Number State | CA
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