Provider Demographics
NPI:1629413844
Name:PARK, SARAH SUEHYUN (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SUEHYUN
Last Name:PARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUE-HYUN
Other - Middle Name:
Other - Last Name:RHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9503 MULLER ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3032
Mailing Address - Country:US
Mailing Address - Phone:562-862-0838
Mailing Address - Fax:
Practice Address - Street 1:10953 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2629
Practice Address - Country:US
Practice Address - Phone:626-579-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily