Doctor Name: | DANIEL PARK |
NPI Number: | 1518197938 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 4301094367 |
Business Practice Address: | 3300 Douglas Blvd Ste 405 Roseville, CA - 956613841 |
Business Phone Number: | 8473379051 |
Business Fax Number: | |
Mailing Address: | 3300 Douglas Blvd., Suite 405, ROSEVILLE |
State: | CA |
Postal Code: | 95611 |
Phone Number: | 8473379051 |
Fax Number: | |
NPI Enumeration Date: | 07/20/2009 |
NPI Last Update Date: | 04/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 4301094367 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |