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Individual
DR. JAE H PARK
Active
Individual
DR. JAE H PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC26114
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ62362Z
BLUESHIELD
CA
Enumeration date
09/21/2006
Last updated
07/09/2007
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