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General NPI Number Information
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NPI Number | 1306900691
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Entity Type | Individual
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Provider Name | DONG-RAE PARK O.M.D., LIC. ACUPUNC
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 11661 PRESTON RD SUITE 170
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City | DALLAS
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State | TX
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Zip | 75230-2745
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Country | US
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Telephone | 214-691-3210
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Fax | 214-739-6262
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Provider Business Mailing Address
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Address Line | 11661 PRESTON RD SUITE 170
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City | DALLAS
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State | TX
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Zip | 75230-2745
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Country | US
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Telephone | 214-691-3210
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Fax | 214-739-6262
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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 | AC00184
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License Number State | TX
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