Healthcare Provider Details

I. General information

NPI: 1568902252
Provider Name (Legal Business Name): WE SUN PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 05/27/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12912 BROOKHURST ST STE 480
GARDEN GROVE CA
92840-4867
US

IV. Provider business mailing address

3650 SANDPIPER WAY
BREA CA
92823-1045
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-6561
  • Fax: 714-527-6563
Mailing address:
  • Phone: 714-403-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: