Provider Demographics
NPI:1700048279
Name:PARK, MIN JUNG (MD, MMSC)
Entity Type:Individual
Prefix:
First Name:MIN JUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W AVENUE L
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7211
Mailing Address - Country:US
Mailing Address - Phone:213-300-1982
Mailing Address - Fax:
Practice Address - Street 1:615 W AVENUE L
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7211
Practice Address - Country:US
Practice Address - Phone:661-618-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192455207X00000X
CAA125606207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery