Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | A91824 | CA |
NPI | 1427190396 |
---|---|
Provider Name | Dr. Jane Lee Park |
First Address | Cupertino, CA 95014-3854 |
Second Address | Stanford, CA 94305-5208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |