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General NPI Number Information
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NPI Number | 1144686577
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Entity Type | Individual
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Provider Name | TONY JUNGWOO PARK
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Gender | Male
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 7212 ORANGETHORPE AVE STE 9A
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City | BUENA PARK
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State | CA
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Zip | 90621-4668
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Country | US
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Telephone | 714-503-6550
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Fax | 714-409-3075
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Provider Business Mailing Address
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Address Line | 53 SCARLET BLOOM
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City | IRVINE
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State | CA
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Zip | 92618-8808
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Country | US
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Telephone | 858-740-4142
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 835101
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95003723
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2020011541
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License Number State | CA
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