MEDICARE: EUN YOUNG PARK L.AC.

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	171100000X	Acupuncturist	AC6024	CA

General Provider Information

NPI Number	:	1255581823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUN YOUNG PARK L.AC.

Provider Business Mailing Address
First Line	:	5524 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-2535
Country	:	US
Telephone Number	:	323-277-8100
Fax Number	:	323-277-4630

Provider Business Practice Location Address
First Line	:	5524 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-2535
Country	:	US
Telephone Number	:	323-277-8100
Fax Number	:	323-277-4630

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

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	09/19/2008

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