Healthcare Provider Details

I. General information

NPI: 1639666365
Provider Name (Legal Business Name): KYUNGHWA PARK PHARMD, APH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 MORSE AVE
SACRAMENTO CA
95825-2135
US

IV. Provider business mailing address

2008 MORSE AVE
SACRAMENTO CA
95825-2135
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5300
  • Fax:
Mailing address:
  • Phone: 916-973-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number75295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: