Individual
KELLY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4501 SAND CREEK RD, ANTIOCH, CA 94531-8687
(925) 813-6500
Mailing address
4501 SAND CREEK RD, ANTIOCH, CA 94531-8687
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20007
CA
207V00000X
Obstetrics & Gynecology Physician
25MB10893000
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/28/2011
Last updated
01/25/2023
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