Provider Demographics
NPI:1275619447
Name:PARK, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2151 N HARBOR BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3826
Mailing Address - Country:US
Mailing Address - Phone:714-446-5900
Mailing Address - Fax:
Practice Address - Street 1:2151 N HARBOR BLVD
Practice Address - Street 2:SUITE 2200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3801
Practice Address - Country:US
Practice Address - Phone:714-446-5900
Practice Address - Fax:714-446-5800
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA75876207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA75876AMedicare PIN