MEDICARE: JOONG Y PARK M D MEDICAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1265716229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOONG Y PARK M D MEDICAL CORP

Provider Business Mailing Address
First Line	:	9828 GARDEN GROVE BLVD STE 201
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9828 GARDEN GROVE BLVD STE 201
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1659
Country	:	US
Telephone Number	:	714-530-9633
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	JOONG Y PARK
Credential	:
Telephone Number	:	714-530-9633

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	11/03/2016

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Directions to “JOONG Y PARK M D MEDICAL CORP ” Practice Location

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