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General NPI Number Information
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NPI Number | 1033516737
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Entity Type | Individual
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Provider Name | CHANGGYU PARK
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Gender | Male
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 500 DEKALB AVE STE 321
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City | BROOKLYN
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State | NY
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Zip | 11205-4808
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Country | US
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Telephone | 646-498-3398
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 604246
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City | BAYSIDE
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State | NY
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Zip | 11360-4246
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Country | US
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Telephone | 646-498-3398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 5412
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License Number State | NY
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