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General NPI Number Information
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NPI Number | 1851541494
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Entity Type | Individual
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Provider Name | JENNY HYOSUN PARK OD
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Gender | Female
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 01/10/2010
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Provider Practice Location Address
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Address Line | 705 E BIDWELL ST STE 10
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City | FOLSOM
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State | CA
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Zip | 95630-3315
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Country | US
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Telephone | 916-983-6211
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Fax |
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Provider Business Mailing Address
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Address Line | 705 E BIDWELL ST STE 10
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City | FOLSOM
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State | CA
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Zip | 95630-3315
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Country | US
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Telephone | 916-983-6211
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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 | 13633 T
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License Number State | CA
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