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General NPI Number Information
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NPI Number | 1316124480
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Entity Type | Individual
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Provider Name | INSUNG PARK L.AC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 239 MATHER AVE
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City | PRINCETON
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State | NJ
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Zip | 08540
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Country | US
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Telephone | 609-240-7060
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Fax | 908-272-3094
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Provider Business Mailing Address
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Address Line | 239 MATHER AVE
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City | PRINCETON
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State | NJ
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Zip | 08560
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Country | US
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Telephone | 732-754-0392
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Fax | 609-520-1099
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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 | 25MZ00036500
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License Number State | NJ
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