MEDICARE: JI WON PARK PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	80366	CA

General Provider Information

NPI Number	:	1134700628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI WON PARK PHARMD

Provider Business Mailing Address
First Line	:	3310 W ADAMS BLVD APT 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-5401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S LA CIENEGA BLVD STE 100
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3339
Country	:	US
Telephone Number	:	310-652-0550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	04/16/2021

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Directions to “ JI WON PARK PHARMD” Practice Location

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