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General NPI Number Information
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NPI Number | 1699895862
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Entity Type | Individual
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Provider Name | SUNGGUK PARK OMD LAC
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 15435 S. WESTERN AVE STE 203
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City | GARDENA
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State | CA
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Zip | 90249
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Country | US
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Telephone | 310-324-2791
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Fax | 310-324-2794
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Provider Business Mailing Address
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Address Line | 15435 S. WESTERN AVE STE 203
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City | GARDENA
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State | CA
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Zip | 90249
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Country | US
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Telephone | 310-324-2791
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Fax | 310-324-2794
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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 | AC9218
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License Number State | CA
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