Provider Demographics
NPI:1194226936
Name:PARK, EUN KYUNG (GNP)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:KYUNG
Last Name:PARK
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S ARDMORE AVE APT 234
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3162
Mailing Address - Country:US
Mailing Address - Phone:213-458-0703
Mailing Address - Fax:
Practice Address - Street 1:209 W ALAMEDA AVE STE 101
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-3023
Practice Address - Country:US
Practice Address - Phone:866-227-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007780363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95007780OtherCALIFORNIA BOARD OF NURSING