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General NPI Number Information
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NPI Number | 1780101832
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Entity Type | Organization
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Legal Business Name | BJ PARK, CHIROPRACTIC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 3020 WILSHIRE BLVD. SUITE 220
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City | LOS ANGELES
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State | CA
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Zip | 90010
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Country | US
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Telephone | 213-251-5860
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Fax | 213-251-5861
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Provider Business Mailing Address
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Address Line | 8540 RESEDA BLVD. SUITE 210
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City | NORTHRIDGE
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State | CA
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Zip | 91324
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Country | US
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Telephone | 818-701-7010
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Fax | 818-701-7015
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Authorized Official
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Title or Position | PRESIDENT
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Name | BUMJIN PARK
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Credential | D.C.
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Telephone | 213-344-7197
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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 | AC-17709
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-28713
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License Number State | CA
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