Provider Demographics
NPI:1497003750
Name:PARK, HYUN-JOO KERI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HYUN-JOO
Middle Name:KERI
Last Name:PARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 12922
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-2922
Mailing Address - Country:US
Mailing Address - Phone:213-700-8208
Mailing Address - Fax:
Practice Address - Street 1:525 ROBERTS LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4799
Practice Address - Country:US
Practice Address - Phone:213-700-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant