Provider Demographics
NPI:1235673237
Name:PARK, JAMES WHA (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WHA
Last Name:PARK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 SOUTH BLOOMFIELD AVE.
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2015
Mailing Address - Country:US
Mailing Address - Phone:562-863-7011
Mailing Address - Fax:562-864-4560
Practice Address - Street 1:11401 SOUTH BLOOMFIELD AVE.
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-863-7011
Practice Address - Fax:562-864-4560
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker