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
1	363LF0000X	Family Nurse Practitioner	15502	CA

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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