MEDICARE: MR. SOONHO PARK ACUPUNCTURIST

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	AC 10912	CA

General Provider Information

NPI Number	:	1922210392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SOONHO PARK ACUPUNCTURIST

Provider Business Mailing Address
First Line	:	3053 W OLYMPIC BLVD
Second Line	:	SUITE 308
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2558
Country	:	US
Telephone Number	:	213-384-7275
Fax Number	:	213-384-7275

Provider Business Practice Location Address
First Line	:	3053 W OLYMPIC BLVD
Second Line	:	SUITE 308
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2558
Country	:	US
Telephone Number	:	213-384-7275
Fax Number	:	213-384-7275

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

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. SOONHO PARK ACUPUNCTURIST” Practice Location

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