Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | G63196 | CA |
NPI | 1053375444 |
---|---|
Provider Name | Dr. John W Park |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94115-3010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G631960 | (05) | CA |
F16612 | (02) | CA |