| Doctor Name: | MR. RUSTIN JIN PARK |
| NPI Number: | 1003112814 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN, BSN |
| License Number: | RN65754 |
| Business Practice Address: | 4000 E Charleston Blvd Suite 130 Las Vegas, NV - 891046659 |
| Business Phone Number: | 7029684020 |
| Business Fax Number: | 7029684040 |
| Mailing Address: | 4000 E Charleston Blvd, Suite 130 LAS VEGAS |
| State: | NV |
| Postal Code: | 891046659 |
| Phone Number: | 7029684020 |
| Fax Number: | 7029684040 |
| NPI Enumeration Date: | 01/27/2011 |
| NPI Last Update Date: | 01/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | RN65754 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |