Provider Demographics
NPI:1053370239
Name:PARK, JASON HYUK (DPT)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:HYUK
Last Name:PARK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4482 BARRANCA PKWY
Mailing Address - Street 2:SUITE 195
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7701
Mailing Address - Country:US
Mailing Address - Phone:949-679-3337
Mailing Address - Fax:949-679-3336
Practice Address - Street 1:4482 BARRANCA PKWY
Practice Address - Street 2:SUITE 195
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7701
Practice Address - Country:US
Practice Address - Phone:949-679-3337
Practice Address - Fax:949-679-3336
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT244542251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT244540OtherBLUE SHIELD PIN
CAAR052OtherMEDICARE GROUP PTAN
CAPT24454OtherPHYSICAL THERAPY BOARD OF CALIFORNIA
CAPT24454OtherPHYSICAL THERAPY BOARD OF CALIFORNIA