MEDICARE: MISS ON JUNG PARK LA.C

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	AC14308	CA

General Provider Information

NPI Number	:	1619254190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ON JUNG PARK LA.C

Provider Business Mailing Address
First Line	:	721 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-3625
Country	:	US
Telephone Number	:	714-486-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 W OLYMPIC BLVD STE 500
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4670
Country	:	US
Telephone Number	:	323-677-4900
Fax Number	:

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

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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Directions to “ MISS ON JUNG PARK LA.C” Practice Location

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