Individual
DR. JIA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
210-08 35TH AVENUE, BAYSIDE, NY 11361-2979
(718) 229-4090
(718) 224-4131
Mailing address
210-08 35TH AVENUE, BAYSIDE, NY 11361-2979
(718) 229-4090
(718) 224-4131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
214047
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02180216
—
NY
Enumeration date
08/30/2006
Last updated
02/14/2017
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