DR. SUSANNA JUNG-A PARK (NPI# 1528140928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528140928 |
| Entity Type | Individual |
| Full Name | DR. SUSANNA JUNG-A PARK |
| Other Name | DR. SUSANNA PARK |
| Credential | MD |
| Practice Address |
11515 El Camino Real Suite 100 San Diego CA 92130-2045 |
| Practice Telephone | 8587946363 |
| Mailing Telephone | 8587946363 |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2012-04-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 54916 | CA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316329477 | Susanna Miran Park | Acupuncturist | 85 South Broadway, Nyack, NY 10960 | 2015-06-25 |
| 1063759165 | Susanna Myrim Park | Chiropractor | 9601 Katy Fwy 430, Houston, TX 77024-1356 | 2013-01-09 |
| 1902881972 | Susanna S. Park | Ophthalmology | 4860 Y St, Suite 2400, Sacramento, CA 95817-2307 | 2005-12-13 |
| Street Address |
11515 EL CAMINO REAL SUITE 100 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92130-2045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669579850 | Kaydee Bork | Physician Assistant | 11515 El Camino Real, Suit 150, San Diego, CA 92130 | 2006-09-20 |
| 1427453182 | Barbara Hitomi Tanaka | Nurse Practitioner | 11515 El Camino Real, Suite 100, San Diego, CA 92130-3038 | 2014-10-23 |
| 1730582826 | Megan Bendinelli | Nurse Practitioner | 11515 El Camino Real, Suite 100, San Diego, CA 92130-3038 | 2014-10-02 |
| 1205163722 | Acupuncture Fertility Center, Inc. | Clinic/Center | 11515 El Camino Real, Suite 150, San Diego, CA 92130-3038 | 2009-11-04 |
| 1316180920 | Jeneanne Paden, L.ac. | Acupuncturist | 11515 El Camino Real, Ste 160, San Diego, CA 92130-3038 | 2009-04-13 |
| 1184892002 | L. Michael Kettel | Obstetrics & Gynecology | 11515 El Camino Real, Suite 100, San Diego, CA 92130-3038 | 2008-02-13 |
| 1962670893 | William P. Hummel | Obstetrics & Gynecology | 11515 El Camino Real, Suite 100, San Diego, CA 92130-3038 | 2008-02-13 |
| 1447434055 | Renee Marni Walker | Acupuncturist | 11515 El Camino Real, Suite 160, San Diego, CA 92130-3038 | 2007-12-19 |
| 1801015227 | Patti A Bennett-deguzman | Social Worker | 11515 El Camino Real, Suite 160, San Diego, CA 92130-3038 | 2007-04-24 |
| 1417037680 | Gilbert Wesley Lee | Surgery | 11515 El Camino Real, Suite 150, San Diego, CA 92130 | 2006-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629692397 | Tlc Family Therapy | Marriage & Family Therapist | 5965 Village Way. Suite 105 #112, San Diego, CA 92130 | 2020-05-29 |
| 1447746169 | Jack Perlov | Psychiatry & Neurology | 3535 Caminito El Rincon, Unit 268, San Diego, CA 92130 | 2018-07-05 |
| 1326551003 | Theotokos, LLC | Pharmacy | 5550 Carmel Mountain Rd Ste 111, San Diego, CA 92130 | 2017-11-16 |
| 1154879146 | Halie Hommes | Occupational Therapist | 12250 El Camino Real Ste 250, San Diego, CA 92130 | 2016-09-19 |
| 1790232015 | Coastal Skin and Eye Institute, Inc. | Ophthalmology | 5550 Carmel Mountain Road, Suite 206, San Diego, CA 92130 | 2016-09-02 |
| 1720534951 | Nosti and Rygg Dental Corporation | Dentist | 5550 Carmel Mountain Road, Ste 200, San Diego, CA 92130 | 2016-08-28 |
| 1831644053 | Marco Savittieri | Dentist | 3715 Ruette De Vl, San Diego, CA 92130 | 2016-08-17 |
| 1336508621 | Discovery Practice Management, Inc | Psychiatric Residential Treatment Facility | 11455 Camino Real, Ste 360, San Diego, CA 92130 | 2016-02-16 |
| 1427434679 | Coast Pediatrics Carmel Valley | Pediatrics | 5965 Village Drive, Suite 201, San Diego, CA 92130 | 2015-08-10 |
| 1659753762 | T Sidal Dds Md Inc | Dentist | 12395 El Camino Real, Suite 304, Torrey Pines Oral & Maxillofacial Surgery, San Diego, CA 92130 | 2015-06-25 |
| Find all providers in zip 92130 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114541463 | Serena Mink | Specialist | 100 Park Plz Apt 407, San Diego, CA 92101-6710 | 2020-06-02 |
| 1023648201 | Pamela Renea Crane | Specialist | 3237 Meade Ave, San Diego, CA 92116-4519 | 2020-01-16 |
| 1184199853 | Oliver Rakeem Taylor | Specialist | 1265 Angelus Ave, San Diego, CA 92114-3108 | 2018-10-09 |
| 1376040923 | Mark Edmond Rierson | Specialist | 2333 1st Ave Ste 106, San Diego, CA 92101-1538 | 2018-04-10 |
| 1790232635 | Cristina Zheng-castruita | Specialist | 9308 Babauta Rd, Apt. 62, San Diego, CA 92129-4922 | 2016-09-08 |
| 1689027955 | Neelam Agashe | Specialist | 3445 Lebon Dr Apt 1215, San Diego, CA 92122-5267 | 2016-07-21 |
| 1376998864 | Briniti Ichull | Specialist | 3941 Kurtz St, San Diego, CA 92110 | 2016-05-03 |
| 1952765935 | Jacqueline Morgan | Specialist | 9625 Black Mountain Rd Ste 300, San Diego, CA 92126-4598 | 2016-04-06 |
| 1710341862 | Comprehensive Medical Reporting Services | Specialist | 9040 Friars Rd., Ste. 410, San Diego, CA 92108 | 2016-04-05 |
| 1790150555 | Mahmood Nazari | Specialist | 6209 Lake Apopka Pl, 6209 Lake Apopka Place, San Diego, CA 92119-3520 | 2015-12-04 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.