MEDICARE: DR. JUSTINE HYOJU PARK MD

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	207N00000X	Dermatology Physician	A88512	CA

General Provider Information

NPI Number	:	1164570180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTINE HYOJU PARK MD

Provider Business Mailing Address
First Line	:	696 HAMPSHIRE RD STE 110
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4456
Country	:	US
Telephone Number	:	818-246-4936
Fax Number	:

Provider Business Practice Location Address
First Line	:	696 HAMPSHIRE RD STE 110
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4456
Country	:	US
Telephone Number	:	805-725-6414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	04/11/2026

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