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General NPI Number Information
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NPI Number | 1760418040
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Entity Type | Organization
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Legal Business Name | GYOUNG PARK MD, INC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST SUITE N-257
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City | SANTA ANA
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State | CA
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Zip | 92701-2201
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Country | US
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Telephone | 714-543-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 E 17TH ST SUITE N-257
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City | SANTA ANA
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State | CA
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Zip | 92701-2201
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Country | US
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Telephone | 714-543-1490
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GYOUNG JAE PARK
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Credential | M.D.
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Telephone | 714-543-1490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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