Provider Demographics
NPI:1497719942
Name:PARK, JONG WON (MD)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:WON
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E CHAPMAN AVE
Mailing Address - Street 2:SUITE #204
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3223
Mailing Address - Country:US
Mailing Address - Phone:714-628-3350
Mailing Address - Fax:714-633-7316
Practice Address - Street 1:2501 E CHAPMAN AVE
Practice Address - Street 2:SUITE #204
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3223
Practice Address - Country:US
Practice Address - Phone:714-628-3350
Practice Address - Fax:714-633-7316
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 44338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine