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NPI Code Detail

MEDICARE: MICHELLE MYOUNGWOO PARK NP, RN

MEDICARE: MICHELLE MYOUNGWOO PARK NP, RN
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
1163W00000XRegistered Nurse847491CA
2163WC1500XCommunity Health Registered Nurse87621CA
3363LF0000XFamily Nurse Practitioner95002767CA

General Provider Information

NPI Number : 1346616745
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MYOUNGWOO PARK NP, RN
Provider Business Mailing Address
First Line : 300 CORPORATE POINTE
Second Line : STE 465
City : CULVER CITY
State : CA
Zip : 90230-8706
Country : US
Telephone Number : 510-981-4100
Fax Number :
Provider Business Practice Location Address
First Line : 3075 ADELINE ST STE 280
Second Line :
City : BERKELEY
State : CA
Zip : 94703-2580
Country : US
Telephone Number : 510-981-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2015
Last Update Date : 08/16/2021

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