MEDICARE: CATHERINE MINJU PARK RDN

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1518588177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MINJU PARK RDN

Provider Business Mailing Address
First Line	:	14730 WILLOW CREEK LN
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-4733
Country	:	US
Telephone Number	:	909-680-0145
Fax Number	:

Provider Business Practice Location Address
First Line	:	14730 WILLOW CREEK LN
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-4733
Country	:	US
Telephone Number	:	909-680-0145
Fax Number	:

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

Provider Enumeration Date	:	05/05/2020
Last Update Date	:	05/05/2020

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