Provider Demographics
NPI:1083839799
Name:PARK, HAE JUNG (MS)
Entity Type:Individual
Prefix:MISS
First Name:HAE JUNG
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 7TH ST # 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3312
Mailing Address - Country:US
Mailing Address - Phone:718-768-2085
Mailing Address - Fax:718-768-2085
Practice Address - Street 1:339 7TH ST # 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3312
Practice Address - Country:US
Practice Address - Phone:718-768-2085
Practice Address - Fax:718-768-2085
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002449171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist