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NPI Code Detail

MEDICARE: GIL JA PARK

MEDICARE: GIL JA 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
1183500000XPharmacist45541CA

General Provider Information

NPI Number : 1396013595
Entity Type Code : Individual
Provider Name (Legal Business Name) : GIL JA PARK
Provider Business Mailing Address
First Line : 7 HIGHFIELD GLN
Second Line :
City : IRVINE
State : CA
Zip : 92618-4042
Country : US
Telephone Number : 949-552-1178
Fax Number :
Provider Business Practice Location Address
First Line : 1330 E 17TH ST
Second Line : T-0286
City : SANTA ANA
State : CA
Zip : 92705-8500
Country : US
Telephone Number : 714-547-1042
Fax Number : 714-547-1042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2011
Last Update Date : 12/02/2011

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Directions to “ GIL JA PARK ” Practice Location

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