Provider Demographics
NPI:1396741518
Name:PARK, SUNG (MD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6283 CLARK RD
Mailing Address - Street 2:STE 5
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-877-5083
Mailing Address - Fax:530-877-5085
Practice Address - Street 1:6283 CLARK RD
Practice Address - Street 2:STE 5
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-877-5083
Practice Address - Fax:530-877-5085
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62508207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A625080Medicaid
P00170570OtherMEDICARE RAILROAD #
CA00A625080Medicaid
CAH09596Medicare UPIN