Provider Demographics
NPI:1538490412
Name:PARK, SAI R (MD)
Entity type:Individual
Prefix:DR
First Name:SAI
Middle Name:R
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 1:728 S POND CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1746
Mailing Address - Country:US
Mailing Address - Phone:925-370-3795
Mailing Address - Fax:925-370-1755
Practice Address - Street 1:728 S POND CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-1746
Practice Address - Country:US
Practice Address - Phone:925-370-3795
Practice Address - Fax:925-370-1755
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE38816172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker