Park, Jung Mok
Park, Jung Mok is an individual health care provider with primary practice located at 11480 Brookshire Ave Suite 204, Downey CA 90241-5026. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Park, Jung Mok can be contacted via phone (562) 862-2775.Contact Information
Primary practice address
11480 Brookshire Ave Suite 204
Downey CA 90241-5026
Phone: (562) 862-2775
Fax: (562) 904-8095
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | A52223 | California |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 52223 | California |
Profile Details
| NPI number | 1508872243 |
|---|---|
| LBN Legal business name | Park, Jung Mok |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 1st, 2006 |
| Last updated | Sep 21st, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508872243 | NPPES |
| California | Other | 00A522230 | BLUE SHIELD |
| California | Other | 160055247 | BLUE SHIELD |
| California | MEDICAID | 00A522230 | BLUE SHIELD |
| California | Other | 160055247 | BLUE SHIELD |
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