Individual
DR. JEAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD. MPH
Contact information
Practice address
9985 SIERRA AVE, FONTANA, CA 92335-6720
(909) 427-5629
Mailing address
9985 SIERRA AVE, FONTANA, CA 92335-6720
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
11014577A
IN
207V00000X
Obstetrics & Gynecology Physician
Primary
A117145
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11014577A
STATE LICENSE
IN
01
—
A117145
CALIFORNIA MEDICAL BOARD
CA
Enumeration date
07/01/2008
Last updated
12/06/2021
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