Individual
DR. SUSANNA S. PARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Contact information
Practice address
4860 Y ST, SUITE 2400, SACRAMENTO, CA 95817-2307
(916) 734-6544
(916) 734-6197
Mailing address
4860 Y ST, SUITE 2400, SACRAMENTO, CA 95817-2307
(916) 734-6544
(916) 734-6197
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G75691
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR002104I
—
CA
Enumeration date
12/13/2005
Last updated
07/08/2007
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