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General NPI Number Information
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NPI Number | 1437280161
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Entity Type | Individual
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Provider Name | JIWON PARK D.P.T., L.AC.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 1 PERLMAN DR SPRING VALLEY
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City | SPRING VALLEY
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State | NY
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Zip | 10977-5281
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Country | US
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Telephone | 845-517-3330
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Fax | 845-517-3331
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Provider Business Mailing Address
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Address Line | 1 PERLMAN DR SPRING VALLEY
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City | SPRING VALLEY
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State | NY
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Zip | 10977-5281
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Country | US
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Telephone | 845-517-3330
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Fax | 845-517-3331
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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 | 002753
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 021333
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License Number State | NY
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