Provider Demographics
NPI:1427190396
Name:PARK, JANE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:LEE
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18721 NEWSOM AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DRIVE
Practice Address - Street 2:BOSWELL BUILDING, ROOM A085
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5208
Practice Address - Country:US
Practice Address - Phone:650-723-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA918242080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology