Provider Demographics
NPI:1386718377
Name:PARK, HANS (MD)
Entity type:Individual
Prefix:DR
First Name:HANS
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 DOW AVE
Mailing Address - Street 2:#204
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7233
Mailing Address - Country:US
Mailing Address - Phone:714-368-0800
Mailing Address - Fax:888-353-6442
Practice Address - Street 1:3002 DOW AVE
Practice Address - Street 2:#204
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7233
Practice Address - Country:US
Practice Address - Phone:714-368-0800
Practice Address - Fax:888-353-6442
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92398207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine