Provider Demographics
NPI:1023392792
Name:PARK, JUNG KYO
Entity Type:Individual
Prefix:
First Name:JUNG KYO
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20435 S VERMONT AVE
Mailing Address - Street 2:UNITE 2
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-3150
Mailing Address - Country:US
Mailing Address - Phone:213-444-1155
Mailing Address - Fax:213-402-5183
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:213-444-1155
Practice Address - Fax:213-402-5183
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist