MEDICARE: JAMES EUN PARK MASSAGE THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MAT6448	HI

General Provider Information

NPI Number	:	1124880521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EUN PARK MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	2256 SEAVIEW AVE # 2130
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-2484
Country	:	US
Telephone Number	:	808-342-1056
Fax Number	:

Provider Business Practice Location Address
First Line	:	7192 KALANIANAOLE HWY STE E206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-1849
Country	:	US
Telephone Number	:	808-797-8094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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