Individual
JEESOON PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13300 HAWTHORNE BLVD, HAWTHORNE, CA 90250-5805
(424) 365-3031
Mailing address
12152 NAPOLI DR, CERRITOS, CA 90703-2773
(310) 402-3751
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
532285
CA
2084P0800X
Psychiatry Physician
95028679
CA
Other
Enumeration date
05/10/2021
Last updated
01/27/2024
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