MEDICARE: KENNETH PARK DACM

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
1	171100000X	Acupuncturist	25NZ00137300	NJ
2	171100000X	Acupuncturist	005964	NY

General Provider Information

NPI Number	:	1306552195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH PARK DACM

Provider Business Mailing Address
First Line	:	418 CHESTNUT ST
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-9306
Country	:	US
Telephone Number	:	201-424-4263
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 CHESTNUT ST
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-9306
Country	:	US
Telephone Number	:	201-424-4263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	02/26/2026

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Directions to “ KENNETH PARK DACM” Practice Location

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