MEDICARE: MRS. YUNG J PARK RPH

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	RPH40035	CA
2	3336C0003X	Community/Retail Pharmacy	PHY36871	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RPH40035	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1982766168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YUNG J PARK RPH

Provider Business Mailing Address
First Line	:	5014 HUNTINGTON DR SOUTH
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1698
Country	:	US
Telephone Number	:	323-222-2362
Fax Number	:	323-225-4171

Provider Business Practice Location Address
First Line	:	5014 HUNTINGTON DR SOUTH
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1698
Country	:	US
Telephone Number	:	323-222-2362
Fax Number	:	323-225-4171

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/13/2008

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