Provider Demographics
NPI:1144416223
Name:PARK, DAVID TODD JR
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TODD
Last Name:PARK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N MARKET BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1238
Mailing Address - Country:US
Mailing Address - Phone:916-922-2771
Mailing Address - Fax:916-922-8609
Practice Address - Street 1:601 N MARKET BLVD STE 350
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1238
Practice Address - Country:US
Practice Address - Phone:916-922-2771
Practice Address - Fax:916-922-8609
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator