Basic Information
| Provider Information | |||||||||
| NPI: | 1285281337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | EUNA | ||||||||
| MiddleName: | LIM | ||||||||
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| OtherLastName: | LIM | ||||||||
| OtherFirstName: | EUN A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2687 E PACIFIC CT | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928219104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148659288 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7212 ORANGETHORPE AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145036550 | ||||||||
| FaxNumber: | 7145090886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2019 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.