MEDICARE: ANGELA SOEON 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
1	171100000X	Acupuncturist	AC17151	CA

General Provider Information

NPI Number	:	1851842066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SOEON PARK

Provider Business Mailing Address
First Line	:	3700 S SEPULVEDA BLVD APT 406
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 6TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-1602
Country	:	US
Telephone Number	:	310-917-2200
Fax Number	:

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

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/20/2023

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Directions to “ ANGELA SOEON PARK ” Practice Location

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