MEDICARE: SHIN PARK

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	13533	CA

General Provider Information

NPI Number	:	1306333216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIN PARK

Provider Business Mailing Address
First Line	:	22478 DENKER AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-4223
Country	:	US
Telephone Number	:	909-861-1015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 S DIAMOND BAR BLVD
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-2208
Country	:	US
Telephone Number	:	909-861-1015
Fax Number	:

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	04/16/2018

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Directions to “ SHIN PARK ” Practice Location

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