Provider Demographics
NPI:1972798452
Name:PARK, JOON Y (PT)
Entity Type:Individual
Prefix:
First Name:JOON
Middle Name:Y
Last Name:PARK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 WILSHIRE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2389
Mailing Address - Country:US
Mailing Address - Phone:213-389-3334
Mailing Address - Fax:213-389-3353
Practice Address - Street 1:3545 WILSHIRE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2389
Practice Address - Country:US
Practice Address - Phone:213-389-3334
Practice Address - Fax:213-389-3353
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist