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General NPI Number Information
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NPI Number | 1699047407
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Entity Type | Individual
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Provider Name | YONG HOON PARK L.AC
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Gender | Male
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 1911 COMMERCENTER EAST SUITE 107
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-890-0401
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Fax | 909-939-2413
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Provider Business Mailing Address
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Address Line | 2076 BRIDGEWOOD WAY
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City | UPLAND
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State | CA
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Zip | 91784
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Country | US
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Telephone | 714-474-3731
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Fax | 909-939-2413
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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 | AC14439
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License Number State | CA
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