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General NPI Number Information
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NPI Number | 1821538463
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Entity Type | Individual
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Provider Name | JIN MAN PARK
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Gender | Male
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 516 PENNSFIELD PL STE 115
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5576
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Country | US
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Telephone | 213-651-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 304 MYRTLE ST UNIT 313
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City | GLENDALE
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State | CA
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Zip | 91203-3579
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Country | US
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Telephone | 213-651-9900
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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 | AC16541
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License Number State | CA
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