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General NPI Number Information
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NPI Number | 1285844027
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Entity Type | Organization
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Legal Business Name | PURE BALANCE HEALING ART CENTER
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 30110 CROWN VALLEY PKWY STE 107
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2043
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Country | US
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Telephone | 949-249-2839
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Fax | 949-249-2839
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Provider Business Mailing Address
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Address Line | 30110 CROWN VALLEY PKWY STE 107
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2043
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Country | US
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Telephone | 949-249-2839
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Fax | 949-249-2839
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | DR. ERIC EUNGSOON PARK
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Credential | L.AC, PH.D.
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Telephone | 949-249-2839
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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 | AC10097
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License Number State | CA
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