Provider Demographics
NPI:1831167378
Name:PARK, INA UNA (MD)
Entity type:Individual
Prefix:
First Name:INA
Middle Name:UNA
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 MARINA BAY PKWY
Mailing Address - Street 2:BUILDING P, 2ND FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-6403
Mailing Address - Country:US
Mailing Address - Phone:510-926-2597
Mailing Address - Fax:510-620-3180
Practice Address - Street 1:850 MARINA BAY PKWY
Practice Address - Street 2:BUILDING P, 2ND FLOOR
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-6403
Practice Address - Country:US
Practice Address - Phone:510-926-2597
Practice Address - Fax:510-620-3180
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA80262OtherCALIFORNIA