MEDICARE: SUKHWA PARK L.AC., PH.D.

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	AC14532	CA

General Provider Information

NPI Number	:	1679930572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUKHWA PARK L.AC., PH.D.

Provider Business Mailing Address
First Line	:	4870 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2634
Country	:	US
Telephone Number	:	213-925-5862
Fax Number	:	323-426-9332

Provider Business Practice Location Address
First Line	:	4870 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029
Country	:	US
Telephone Number	:	323-251-1750
Fax Number	:	323-426-9332

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

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	01/02/2020

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