MEDICARE: SAEONG BIN PARK CA

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	L.AC 7811	CA

General Provider Information

NPI Number	:	1447284716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAEONG BIN PARK CA

Provider Business Mailing Address
First Line	:	650 ALAMO PINTADO RD STE 104
Second Line	:
City	:	SOLVANG
State	:	CA
Zip	:	93463-2266
Country	:	US
Telephone Number	:	805-686-0805
Fax Number	:	805-686-0805

Provider Business Practice Location Address
First Line	:	650 ALAMO PINTADO RD STE 104
Second Line	:
City	:	SOLVANG
State	:	CA
Zip	:	93463-2266
Country	:	US
Telephone Number	:	805-686-0805
Fax Number	:	805-686-0805

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/26/2011

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Directions to “ SAEONG BIN PARK CA” Practice Location

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