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General NPI Number Information
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NPI Number | 1396013595
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Entity Type | Individual
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Provider Name | GIL JA PARK
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Gender | Female
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 1330 E 17TH ST T-0286
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City | SANTA ANA
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State | CA
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Zip | 92705-8500
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Country | US
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Telephone | 714-547-1042
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Fax | 714-547-1042
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Provider Business Mailing Address
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Address Line | 7 HIGHFIELD GLN
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City | IRVINE
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State | CA
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Zip | 92618-4042
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Country | US
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Telephone | 949-552-1178
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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 | 45541
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License Number State | CA
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