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NPI Code Detail

MEDICARE: SEON JI PARK MFC

MEDICARE: SEON JI PARK MFC
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
1106H00000XMarriage & Family TherapistMFC42519CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407895626
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEON JI PARK MFC
Provider Business Mailing Address
First Line : 12450 VAN NUYS BLVD STE 200
Second Line :
City : PACOIMA
State : CA
Zip : 91331-1393
Country : US
Telephone Number : 818-896-1161
Fax Number : 818-896-5069
Provider Business Practice Location Address
First Line : 1000 CORPORATE CENTER DR STE 650
Second Line :
City : MONTEREY PARK
State : CA
Zip : 91754-7639
Country : US
Telephone Number : 626-966-1776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 05/03/2023

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Directions to “ SEON JI PARK MFC” Practice Location

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