Individual
JISUN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
747 BROADWAY, SEATTLE, WA 98122-4379
(202) 714-2893
Mailing address
130 NE 95TH ST APT A307, SEATTLE, WA 98115-2056
(202) 714-2893
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86064132
WA
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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