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General NPI Number Information
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NPI Number | 1508335209
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Entity Type | Individual
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Provider Name | JINA PARK
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Gender | Female
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE ATTN: ACHJ-CLQ-C
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City | TACOMA
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State | WA
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Zip | 98433
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Country | US
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Telephone | 253-986-0982
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Fax |
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Provider Business Mailing Address
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Address Line | 9138 MIL PARK 108
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City | TACOMA
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State | WA
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Zip | 98433
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Country | US
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Telephone | 213-663-3164
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 345112
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License Number State | TX
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