MEDICARE: DR. YOUNGHEE PARK D.C., L.AC.

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	111N00000X	Chiropractor	DC28715	CA
2	171100000X	Acupuncturist	AC10635	CA

General Provider Information

NPI Number	:	1679769004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUNGHEE PARK D.C., L.AC.

Provider Business Mailing Address
First Line	:	6031 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-2304
Country	:	US
Telephone Number	:	714-757-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	6031 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-2304
Country	:	US
Telephone Number	:	714-757-5867
Fax Number	:

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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