Individual
DR. JONGSOOK SUSIE PARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12665 GARDEN GROVE BLVD #505, GARDEN GROVE, CA 92843
(714) 534-2110
(714) 534-1155
Mailing address
12665 GARDEN GROVE BLVD #505, GARDEN GROVE, CA 92843
(714) 534-2110
(714) 534-1155
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
C41515
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C415150
—
CA
Enumeration date
04/17/2006
Last updated
07/08/2007
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