Individual
DR. SUSAN JIN-SUN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
661 SIERRA ROSE DR, RENO, NV 89511
(775) 982-8255
(775) 982-8251
Mailing address
1155 MILL ST # MCM14, RENO, NV 89502-1576
(775) 982-5262
(775) 982-3900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13322
NV
207QS0010X
Sports Medicine (Family Medicine) Physician
13322
NV
207QS0010X
Sports Medicine (Family Medicine) Physician
A98140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12139950
CAQH
—
Enumeration date
07/14/2008
Last updated
06/21/2021
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