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General NPI Number Information
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NPI Number | 1134700628
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Entity Type | Individual
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Provider Name | JI WON PARK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 240 S LA CIENEGA BLVD STE 100
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3339
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Country | US
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Telephone | 310-652-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 3310 W ADAMS BLVD APT 104
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City | LOS ANGELES
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State | CA
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Zip | 90018-5401
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 80366
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License Number State | CA
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