Active NPI
Sangwon James Park, RPH
- Pharmacist
- Anaheim, CA
National Provider Identifier
1790418390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 86190
- Practice address
- 1700 W Cerritos Ave Unit 208
Anaheim, CA 92804-6180 - Phone
- (714) 262-0925
- NPI assigned
- Jul 1, 2022
- Last updated
- Jul 1, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 86190 | CA | Primary |
Addresses
Primary practice location
1700 W Cerritos Ave Unit 208
Anaheim, CA 92804-6180
Mailing address
1700 W Cerritos Ave Unit 208
Anaheim, CA 92804-6180
Phone (714) 262-0925
Other practice location 1
1726 Superior Ave
Costa Mesa, CA 92627-3615
Phone (949) 629-9714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86190 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656633600000",
"number": "1790418390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 W CERRITOS AVE UNIT 208",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928046180",
"telephone_number": "714-262-0925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 W CERRITOS AVE UNIT 208",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928046180",
"telephone_number": "714-262-0925"
}
],
"practiceLocations": [
{
"address_1": "1726 Superior Ave",
"address_purpose": "LOCATION",
"city": "Costa Mesa",
"state": "CA",
"postal_code": "926273615",
"country_code": "US",
"telephone_number": "949-629-9714",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PARK",
"first_name": "SANGWON",
"middle_name": "JAMES",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-01",
"last_updated": "2022-07-01",
"certification_date": "2022-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "86190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.