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General NPI Number Information
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NPI Number | 1811641293
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Entity Type | Individual
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Provider Name | JAMES MYENG PARK
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Gender | Male
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 18211 AVOLINDA DR
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City | YORBA LINDA
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State | CA
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Zip | 92886-2401
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Country | US
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Telephone | 747-203-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 18211 AVOLINDA DR
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City | YORBA LINDA
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State | CA
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Zip | 92886-2401
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Country | US
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Telephone |
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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 | 69060
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 84614
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License Number State | CA
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