Provider Demographics
NPI:1154764694
Name:D. J. JOHN PARK, M.D., INC.
Entity type:Organization
Organization Name:D. J. JOHN PARK, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG JUN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-326-7715
Mailing Address - Street 1:180 NEWPORT CENTER DR STE 170
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0937
Mailing Address - Country:US
Mailing Address - Phone:949-777-6883
Mailing Address - Fax:949-629-4011
Practice Address - Street 1:180 NEWPORT CENTER DR STE 170
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0937
Practice Address - Country:US
Practice Address - Phone:949-777-6883
Practice Address - Fax:949-629-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98835261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery