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General NPI Number Information
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NPI Number | 1669624052
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Entity Type | Individual
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Provider Name | JENNY Y PARK O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 30606 SANTA MARGARITA PKWY STE A103
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-4500
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Country | US
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Telephone | 949-658-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 30606 SANTA MARGARITA PKWY STE A103
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-4500
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Country | US
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Telephone | 949-658-2670
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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 | 046010147
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License Number State | IL
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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 | 14361
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License Number State | CA
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