Provider Demographics
NPI:1780191312
Name:PARK, MINJUNG K (PHD)
Entity type:Individual
Prefix:DR
First Name:MINJUNG
Middle Name:K
Last Name:PARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2019
Mailing Address - Country:US
Mailing Address - Phone:562-860-0586
Mailing Address - Fax:562-860-0767
Practice Address - Street 1:4881 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-2019
Practice Address - Country:US
Practice Address - Phone:562-860-0586
Practice Address - Fax:562-860-0767
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist