Healthcare Provider Details

I. General information

NPI: 1962532135
Provider Name (Legal Business Name): SEUNG BAI PARK O.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CONTINENTAL DR
RENO NV
89509-3431
US

IV. Provider business mailing address

120 CONTINENTAL DR
RENO NV
89509-3431
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-3302
  • Fax: 775-786-1239
Mailing address:
  • Phone: 775-786-3302
  • Fax: 775-786-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number50
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: