Provider Demographics
NPI:1366754277
Name:PARK, SEONG HYE
Entity type:Individual
Prefix:
First Name:SEONG HYE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 KNOLLWOOD CT APT 22
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8980
Mailing Address - Country:US
Mailing Address - Phone:530-350-7749
Mailing Address - Fax:
Practice Address - Street 1:2600 KNOLLWOOD CT APT 22
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8980
Practice Address - Country:US
Practice Address - Phone:530-350-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH56577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist