Individual
MR. JAMES JONGTAK PARK
Active
Individual
MR. JAMES JONGTAK PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
20A7365
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00AX73650
MEDI-CAL
CA
01
—
ZZZ04904Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/11/2006
Last updated
07/26/2007
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