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General NPI Number Information
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NPI Number | 1356752372
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Entity Type | Individual
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Provider Name | JENNY PARK O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 6600 TOPANGA CANYON BLVD UNIT 1
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City | CANOGA PARK
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State | CA
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Zip | 91303-2601
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Country | US
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Telephone | 818-883-8220
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Fax | 818-348-7724
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Provider Business Mailing Address
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Address Line | 6600 TOPANGA CANYON BLVD
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City | CANOGA PARK
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State | CA
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Zip | 91303-2609
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Country | US
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Telephone | 818-883-8220
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Fax | 818-348-7724
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14630
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14630TLG
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License Number State | CA
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