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Individual
TAE J. PARK
Active
Individual
TAE J. PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A90047
CA
207R00000X
Internal Medicine Physician
Primary
S1480
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A900470
—
CA
Enumeration date
05/30/2006
Last updated
09/15/2025
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