Provider Demographics
NPI:1033685177
Name:PARK, PETER SUNGIL (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SUNGIL
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31874 SUMMER GRAPE CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8633
Mailing Address - Country:US
Mailing Address - Phone:951-926-9840
Mailing Address - Fax:
Practice Address - Street 1:31874 SUMMER GRAPE CT
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8633
Practice Address - Country:US
Practice Address - Phone:951-926-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33486207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology