Justin Park
Student in an Organized Health Care Education/Training Program in West Hollywood, CA. Individual provider (NPI-1).
NPI number1710780903
StatusActive
Last updated in NPPESNov 8, 2025
Details
- NPI
- 1710780903
- Entity type
- Individual (NPI-1)
- Name
- Justin Park
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 31, 2025
- Certification date
- Nov 8, 2025
- Last updated
- Nov 8, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
8700 Beverly Blvd Ste 3622West Hollywood, CA 90048-1804
Phone 310-423-7417
Mailing address
8700 Beverly Blvd Ste 3622West Hollywood, CA 90048-1804
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