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General NPI Number Information
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NPI Number | 1457511123
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Entity Type | Individual
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Provider Name | SUSAN LEE PARK NP, L AC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 2700 ALTON PKWY STE 233
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City | IRVINE
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State | CA
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Zip | 92606-2646
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Country | US
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Telephone | 949-475-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 19745 E COLIMA RD SUITE 12
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748
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Country | US
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Telephone | 909-595-5550
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Fax |
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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 | CA10252
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 95035073
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License Number State | CA
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