Provider Demographics
NPI:1578009106
Name:PARK, YUJIN
Entity Type:Individual
Prefix:
First Name:YUJIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13091 GALWAY ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1633
Mailing Address - Country:US
Mailing Address - Phone:714-539-4544
Mailing Address - Fax:714-893-8625
Practice Address - Street 1:13091 GALWAY ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1633
Practice Address - Country:US
Practice Address - Phone:714-539-4544
Practice Address - Fax:714-893-8625
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT129389101Y00000X
CA129389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor