Healthcare Provider Details

I. General information

NPI: 1811295413
Provider Name (Legal Business Name): SEON HWA PARK L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2011
Last Update Date: 03/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 W 32ND ST STE 1001
NEW YORK NY
10001-3880
US

IV. Provider business mailing address

38 W 32ND ST STE 1001
NEW YORK NY
10001-3880
US

V. Phone/Fax

Practice location:
  • Phone: 212-714-1004
  • Fax: 212-714-1009
Mailing address:
  • Phone: 212-714-1004
  • Fax: 212-714-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number004553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: