Provider Demographics
NPI:1114216017
Name:PARK, WON WOO (DC)
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:WOO
Last Name:PARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 N GARFIELD AVE
Mailing Address - Street 2:SUITE A 2ND FL
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1707
Mailing Address - Country:US
Mailing Address - Phone:626-280-2818
Mailing Address - Fax:626-280-2848
Practice Address - Street 1:318 N GARFIELD AVE
Practice Address - Street 2:SUITE A 2ND FL
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1707
Practice Address - Country:US
Practice Address - Phone:626-280-2818
Practice Address - Fax:626-280-2848
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor