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General NPI Number Information
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NPI Number | 1629220074
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Entity Type | Individual
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Provider Name | JEONG MIN PARK L.AC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 1029 1/2 S BERENDO ST
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City | LOS ANGELES
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State | CA
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Zip | 90006-2603
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Country | US
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Telephone | 213-388-1250
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Fax | 213-388-1350
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Provider Business Mailing Address
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Address Line | 1029 1/2 S BERENDO ST
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City | LOS ANGELES
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State | CA
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Zip | 90006-2603
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Country | US
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Telephone | 213-388-1250
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Fax | 213-388-1350
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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 | AC12582
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License Number State | CA
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