| Doctor Name: | MR. JUNG HO PARK |
| NPI Number: | 1649588906 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 11301 Wilshire Blvd Los Angeles, CA - 900731003 |
| Business Phone Number: | 3104783711 |
| Business Fax Number: | |
| Mailing Address: | 1350 Midvale Ave Apt 120, LOS ANGELES |
| State: | CA |
| Postal Code: | 900246340 |
| Phone Number: | 2135004047 |
| Fax Number: | |
| NPI Enumeration Date: | 09/21/2010 |
| NPI Last Update Date: | 09/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 293D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Laboratories |
| Taxonomy Classification: | Physiological Laboratory |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |