Provider Demographics
NPI:1730346024
Name:PARK, MICHELLE JO (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JO
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21520 YORBA LINDA BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3764
Mailing Address - Country:US
Mailing Address - Phone:949-864-6784
Mailing Address - Fax:949-423-0140
Practice Address - Street 1:541 E CHAPMAN AVE STE A2
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1648
Practice Address - Country:US
Practice Address - Phone:949-864-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA106354207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine