Provider Demographics
NPI:1487193736
Name:PARK, JI YOUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JI YOUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2211
Mailing Address - Country:US
Mailing Address - Phone:310-275-2117
Mailing Address - Fax:310-275-2988
Practice Address - Street 1:8700 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2206
Practice Address - Country:US
Practice Address - Phone:310-275-2117
Practice Address - Fax:310-275-2988
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist