MEDICARE: DR. HANS PARK MD

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	207Q00000X	Family Medicine Physician	A92398	CA
2	208D00000X	General Practice Physician	A92398	CA

General Provider Information

NPI Number	:	1386718377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANS PARK MD

Provider Business Mailing Address
First Line	:	3002 DOW AVE
Second Line	:	#204
City	:	TUSTIN
State	:	CA
Zip	:	92780-7233
Country	:	US
Telephone Number	:	714-368-0800
Fax Number	:	888-353-6442

Provider Business Practice Location Address
First Line	:	3002 DOW AVE
Second Line	:	#204
City	:	TUSTIN
State	:	CA
Zip	:	92780-7233
Country	:	US
Telephone Number	:	714-368-0800
Fax Number	:	888-353-6442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	02/12/2020

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Directions to “ DR. HANS PARK MD” Practice Location

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