| Sung-un Justin Park M.d., Inc. | |
|
3055 W Orange Ave Ste 101 Anaheim CA 92804-3152 | |
| (714) 484-8054 | |
| (714) 484-8072 |
| Full Name | Sung-un Justin Park M.d., Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3055 W Orange Ave Ste 101, Anaheim, California |
| Authorized Official Name and Position | Candice Park (OFFICE MANAGER) |
| Authorized Official Contact | 7144848054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sung-un Justin Park M.d., Inc. 3055 W Orange Ave Ste 101 Anaheim CA 92804-3152 Ph: (714) 484-8054 | Sung-un Justin Park M.d., Inc. 3055 W Orange Ave Ste 101 Anaheim CA 92804-3152 Ph: (714) 484-8054 |
| NPI Number | 1750578761 |
|---|---|
| Provider Enumeration Date | 10/03/2007 |
| Last Update Date | 05/23/2023 |
| Certification Date | 05/23/2023 |
| Medicare PECOS PAC ID | 3375510498 |
|---|---|
| Medicare Enrollment ID | O20040916000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750578761 | NPI | - | NPPES |
| 00A487041 | Medicaid | CA | |
| A48704 | Other | CA | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | A48704 (California) | Primary |
| Provider Name | Sung Un Park |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649298084 PECOS PAC ID: 9638146756 Enrollment ID: I20040917000285 |
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