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General NPI Number Information
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NPI Number | 1649955774
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Entity Type | Individual
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Provider Name | SEON SOO PARK L.AC.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 3030 W OLYMPIC BLVD STE 211
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City | LOS ANGELES
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State | CA
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Zip | 90006-6509
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Country | US
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Telephone | 213-703-6939
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 HENRIETTA AVE
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City | LA CRESCENTA
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State | CA
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Zip | 91214-1210
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Country | US
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Telephone | 213-703-8439
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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 | AC14036
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License Number State | CA
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