Provider Demographics
NPI:1437315827
Name:PARK, JINHEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JINHEE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8987 E TANQUE VERDE RD STE 3091025
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9610
Mailing Address - Country:US
Mailing Address - Phone:510-499-6766
Mailing Address - Fax:
Practice Address - Street 1:8987 E TANQUE VERDE RD
Practice Address - Street 2:STE 309-1025
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9610
Practice Address - Country:US
Practice Address - Phone:510-499-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126787207Q00000X, 390200000X
HI21975208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program