Individual
DAI PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
A101619
CA
207R00000X
Internal Medicine Physician
45278
TN
207R00000X
Internal Medicine Physician
A101619
CA
Other
Enumeration date
05/31/2007
Last updated
12/22/2021
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