Provider Demographics
NPI:1649298084
Name:PARK, SUNG-UN JUSTIN (MD)
Entity type:Individual
Prefix:MR
First Name:SUNG-UN
Middle Name:JUSTIN
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3055 W ORANGE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-484-8054
Mailing Address - Fax:714-484-8072
Practice Address - Street 1:3055 W ORANGE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-484-8054
Practice Address - Fax:714-484-8072
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA487042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487041Medicaid
CA00A487041Medicaid
CAW17951Medicare ID - Type Unspecified