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NPI Code Detail

MEDICARE: DR. SOONJU PARK

MEDICARE:  DR. SOONJU  PARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturist13721CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AC 13721OTHERCACALIFORNICA ACUPUNCTURIST

General Provider Information

NPI Number : 1154619872
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SOONJU PARK
Provider Business Mailing Address
First Line : 2727 W 6TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057
Country : US
Telephone Number : 213-738-0712
Fax Number :
Provider Business Practice Location Address
First Line : 2727 W 6TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-3111
Country : US
Telephone Number : 213-738-0712
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2011
Last Update Date : 07/21/2022

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Directions to “ DR. SOONJU PARK ” Practice Location

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