Healthcare Provider Details

I. General information

NPI: 1881518520
Provider Name (Legal Business Name): JEAN YUNJIN PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD STE 200
PASADENA CA
91105-2552
US

IV. Provider business mailing address

3075 FOOTHILL BLVD UNIT 128
LA CRESCENTA CA
91214-2790
US

V. Phone/Fax

Practice location:
  • Phone: 626-723-3099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: