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General NPI Number Information
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NPI Number | 1083324370
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Entity Type | Individual
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Provider Name | JEE WON PARK
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 840 N AVENUE 66
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City | LOS ANGELES
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State | CA
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Zip | 90042-1508
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Country | US
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Telephone | 310-766-6264
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Fax |
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Provider Business Mailing Address
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Address Line | 2933 EL NIDO DR
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City | ALTADENA
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State | CA
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Zip | 91001-4529
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Country | US
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Telephone | 626-395-7100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 115389
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License Number State | CA
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