Individual
DR. MICHAEL KWANSUP PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1940 WEBSTER ST, 2ND FLOOR, OAKLAND, CA 94612-2920
(510) 463-4700
(510) 463-4722
Mailing address
5700 TELEGRAPH AVE, STE 100, OAKLAND, CA 94609-1710
(510) 463-4700
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
G75378
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E91026
MEDICARE
CA
Enumeration date
10/16/2006
Last updated
08/27/2019
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