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General NPI Number Information
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NPI Number | 1164723946
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Entity Type | Organization
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Legal Business Name | CHULHOON PARK, ACUPUNCTURE,INC.
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 8635 W 3RD ST STE 465W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6111
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Country | US
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Telephone | 323-810-6259
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 STARBUCK ST
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City | FULLERTON
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State | CA
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Zip | 92833-5670
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Country | US
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Telephone | 323-810-6259
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHULHOON PARK
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Credential | L.AC.
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Telephone | 323-810-6259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC 13066
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License Number State | CA
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