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General NPI Number Information
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NPI Number | 1407659360
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Entity Type | Individual
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Provider Name | KWANGHWI PARK RN
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Gender | Male
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 2570 48TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-1541
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Country | US
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Telephone | 916-734-2145
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Fax |
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Provider Business Mailing Address
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Address Line | 15028 CROSS STONE DR
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City | SAN DIEGO
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State | CA
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Zip | 92127-4423
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Country | US
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Telephone | 201-787-1387
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 95272857
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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