Healthcare Provider Details

I. General information

NPI: 1760667349
Provider Name (Legal Business Name): JOO HYUN PARK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SAN PABLO AVE
BERKELEY CA
94702-2498
US

IV. Provider business mailing address

5860 SMITH AVE
NEWARK CA
94560-4633
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-1643
  • Fax:
Mailing address:
  • Phone: 510-505-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH60111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: