Healthcare Provider Details

I. General information

NPI: 1457511123
Provider Name (Legal Business Name): SUSAN LEE PARK NP, L AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 ALTON PKWY STE 233
IRVINE CA
92606-2646
US

IV. Provider business mailing address

19745 E COLIMA RD SUITE 12
ROWLAND HEIGHTS CA
91748
US

V. Phone/Fax

Practice location:
  • Phone: 949-475-2500
  • Fax:
Mailing address:
  • Phone: 909-595-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA10252
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95035073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: