Provider Demographics
NPI:1649287152
Name:PARK, KYUNG SOOK (MD)
Entity type:Individual
Prefix:MRS
First Name:KYUNG
Middle Name:SOOK
Last Name:PARK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3484 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1000
Mailing Address - Country:US
Mailing Address - Phone:408-293-3333
Mailing Address - Fax:408-244-3361
Practice Address - Street 1:3484 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1000
Practice Address - Country:US
Practice Address - Phone:408-293-3333
Practice Address - Fax:408-244-3361
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-12-18
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Provider Licenses
StateLicense IDTaxonomies
CAA36838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE78135Medicare UPIN