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General NPI Number Information
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NPI Number | 1730619032
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Entity Type | Individual
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Provider Name | JIN PARK L.AC
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Gender | Male
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 1096 N WESTERN AVE STE 107
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City | LOS ANGELES
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State | CA
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Zip | 90029-2340
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Country | US
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Telephone | 323-645-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 943 S NEW HAMPSHIRE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90006-1618
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Country | US
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Telephone |
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC7602
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC7602
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License Number State | CA
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