Provider Demographics
NPI:1164570180
Name:PARK, JUSTINE HYOJU (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:HYOJU
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 ARDEN AVE STE 435
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4044
Mailing Address - Country:US
Mailing Address - Phone:818-246-4936
Mailing Address - Fax:818-246-4937
Practice Address - Street 1:435 ARDEN AVE STE 435
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4044
Practice Address - Country:US
Practice Address - Phone:818-246-4936
Practice Address - Fax:818-246-4937
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88512207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology