Individual
DR. JUNG MOK PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11480 BROOKSHIRE AVE, SUITE 204, DOWNEY, CA 90241-5026
(562) 862-2775
(562) 904-8095
Mailing address
75 REMITTANCE DR, DEPT 6008, CHICAGO, IL 60675-6008
(562) 282-1419
(562) 920-4642
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
52223
CA
207V00000X
Obstetrics & Gynecology Physician
A52223
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A522230
BLUE SHIELD
CA
05
—
00A522230
—
CA
01
—
160055247
MEDICARE RAILROAD
CA
Enumeration date
08/01/2006
Last updated
09/21/2016
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