Healthcare Provider Details

I. General information

NPI: 1083989693
Provider Name (Legal Business Name): HYUN HO PARK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 N BERKELEY LAKE RD NW
DULUTH GA
30096-3002
US

IV. Provider business mailing address

384 FRIARS HEAD DR
SUWANEE GA
30024-7643
US

V. Phone/Fax

Practice location:
  • Phone: 770-337-7608
  • Fax:
Mailing address:
  • Phone: 770-337-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number578
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: