Individual
DR. KENNETH J PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2 W FERN AVE, REDLANDS, CA 92373
(909) 793-3311
(805) 354-7102
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
14077
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB243726
MEDICARE ID
CA
Enumeration date
05/11/2011
Last updated
01/04/2026
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