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General NPI Number Information
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NPI Number | 1629658992
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Entity Type | Individual
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Provider Name | SEONYEONG PARK
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Gender | Female
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 3154 W. OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006
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Country | US
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Telephone | 323-731-4696
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Fax |
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Provider Business Mailing Address
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Address Line | 3785 WILSHIRE BLVD APT 2107
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City | LOS ANGELES
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State | CA
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Zip | 90010-2895
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Country | US
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Telephone | 213-718-0933
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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 | RPH84173
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License Number State | CA
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