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NPI Code Detail

MEDICARE: PETER YONGSUNG PARK MSW

MEDICARE: PETER YONGSUNG PARK MSW
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
1101YM0800XMental Health Counselor
2225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1265788616
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER YONGSUNG PARK MSW
Provider Business Mailing Address
First Line : 1665 W ADAMS BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90007-1533
Country : US
Telephone Number : 909-348-2030
Fax Number :
Provider Business Practice Location Address
First Line : 1665 W ADAMS BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90007-1533
Country : US
Telephone Number : 909-348-2035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2012
Last Update Date : 06/20/2017

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Directions to “ PETER YONGSUNG PARK MSW” Practice Location

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