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NPI Code Detail

MEDICARE: JI HYE PARK FNP

MEDICARE: JI HYE PARK FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner15502CA

General Provider Information

NPI Number : 1063477016
Entity Type Code : Individual
Provider Name (Legal Business Name) : JI HYE PARK FNP
Provider Business Mailing Address
First Line : 1 MEDICAL PLAZA DR
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3037
Country : US
Telephone Number : 323-580-1382
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEDICAL PLAZA DR
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3037
Country : US
Telephone Number : 916-781-5000
Fax Number : 916-781-5055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 12/13/2019

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Directions to “ JI HYE PARK FNP” Practice Location

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