Provider Demographics
NPI:1952126815
Name:PARK, MINJUNG
Entity type:Individual
Prefix:
First Name:MINJUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28431 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1521
Mailing Address - Country:US
Mailing Address - Phone:213-507-5903
Mailing Address - Fax:
Practice Address - Street 1:28431 MAYFAIR DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91354-1521
Practice Address - Country:US
Practice Address - Phone:213-703-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily