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NPI Code Detail

MEDICARE: MR. JOHNNY PARK HAD

MEDICARE: MR. JOHNNY PARK HAD
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
1237700000XHearing Instrument Specialist7708CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17708OTHERCAHEARING AID DISPENSER

General Provider Information

NPI Number : 1396015152
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHNNY PARK HAD
Provider Business Mailing Address
First Line : 1058 S VERMONT AVE
Second Line : SUITE 109
City : LOS ANGELES
State : CA
Zip : 90006-2721
Country : US
Telephone Number : 213-368-6300
Fax Number :
Provider Business Practice Location Address
First Line : 1058 S VERMONT AVE
Second Line : SUITE 109
City : LOS ANGELES
State : CA
Zip : 90006-2721
Country : US
Telephone Number : 213-368-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2012
Last Update Date : 02/02/2012

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