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Individual
DR. JOHN PARK
Active
Individual
DR. JOHN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
30065
CA
103TC0700X
Clinical Psychologist
Primary
PSY30065
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
09/19/2012
Last updated
07/27/2018
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