Provider Demographics
NPI:1144407230
Name:PARK, SUNG AH (LAC, PHD, QME)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:AH
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC, PHD, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 E COMMONWEALTH AVE # A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4514
Mailing Address - Country:US
Mailing Address - Phone:714-870-7575
Mailing Address - Fax:714-870-7576
Practice Address - Street 1:670 E COMMONWEALTH AVE # A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4514
Practice Address - Country:US
Practice Address - Phone:714-870-7575
Practice Address - Fax:714-870-7576
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6749171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist