Provider Demographics
NPI:1164677464
Name:PARK, GRACE JIYOUNG (DO , MPH)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:JIYOUNG
Last Name:PARK
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Gender:F
Credentials:DO , MPH
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Mailing Address - Street 1:15446 S WESTERN AVE
Mailing Address - Street 2:SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4319
Mailing Address - Country:US
Mailing Address - Phone:310-965-4821
Mailing Address - Fax:
Practice Address - Street 1:15446 S WESTERN AVE
Practice Address - Street 2:SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4319
Practice Address - Country:US
Practice Address - Phone:310-965-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2021-12-06
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Provider Licenses
StateLicense IDTaxonomies
CA20A10562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine