Provider Demographics
NPI:1558563270
Name:PARK, JUNG OCK (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUNG
Middle Name:OCK
Last Name:PARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13127 OLD WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2406
Mailing Address - Country:US
Mailing Address - Phone:858-248-6163
Mailing Address - Fax:
Practice Address - Street 1:9065 EDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3037
Practice Address - Country:US
Practice Address - Phone:619-956-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse