Individual
SUE JIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
840776
CA
363LF0000X
Family Nurse Practitioner
95005086
CA
Other
Enumeration date
10/31/2017
Last updated
01/27/2022
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