MEDICARE: HEUNG S PARK 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	171100000X	Acupuncturist	AC6098	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871781419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEUNG S PARK L.AC.

Provider Business Mailing Address
First Line	:	258 S OXFORD AVE STE 102
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-5172
Country	:	US
Telephone Number	:	213-500-6162
Fax Number	:	323-468-9536

Provider Business Practice Location Address
First Line	:	258 S OXFORD AVE STE 102
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-5172
Country	:	US
Telephone Number	:	213-500-6162
Fax Number	:	323-468-9536

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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Directions to “ HEUNG S PARK L.AC.” Practice Location

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