Healthcare Provider Details

I. General information

NPI: 1598835340
Provider Name (Legal Business Name): RICHARD PARK AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 W 6TH ST STE 617
LOS ANGELES CA
90020-2553
US

IV. Provider business mailing address

12131 BERTHA ST
CERRITOS CA
90703-7520
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-0007
  • Fax: 866-621-2931
Mailing address:
  • Phone: 213-383-0007
  • Fax: 866-621-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: