Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G073810 | CA |
NPI | 1003963364 |
---|---|
Provider Name | Christine Hyunsun Park |
First Address | Laguna Niguel, CA 92607-6803 |
Second Address | Laguna Beach, CA 92651-6785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G36610 | (02) |