MEDICARE: JOOHWA PARK

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	42530	CA

General Provider Information

NPI Number	:	1235450941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOOHWA PARK

Provider Business Mailing Address
First Line	:	6130 W SUNSET BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-6424
Country	:	US
Telephone Number	:	323-467-4201
Fax Number	:	323-467-3550

Provider Business Practice Location Address
First Line	:	6130 W SUNSET BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-6424
Country	:	US
Telephone Number	:	323-467-4201
Fax Number	:	323-467-3550

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

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	06/16/2010

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Directions to “ JOOHWA PARK ” Practice Location

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